Graduate San Francisco SPCA Academy for Dog Trainers

Registration Form

We appreciate your interest in Opportunity Barks! Please fill out the form below (one form per dog) to set up a temperament evaluation for your dog. After submitting the form, we will contact you within 1-3 days to make an evaluation appointment.

* Required

Services
What Services are you interested in?
Daycare Overnight Care
Day Care: For Daycare, please provide which day(s) you would like to drop off your dog.

Overnight Care: For Overnight Care, please provide which nights you would like your dog to stay.

Contact Information
*First Name:**
*Last Name:**
*Email:**
*Address:**
*City:**
*State:**
*Zip Code:**
REQUIRED: Please provide at least one phone number where we can best reach you.
Home Phone:
Work Phone:
Cell Phone or Pager:

Please list others who may need to pick up your dog: (We will only release your dog to a person listed on this form.)
Name:
Phone:
Name:
Phone:

EMERGENCY CONTACT (This is a LOCAL person whom we can contact if guardians are out of the area or unable to pick up your dog for any reason.)
Name:
Address:
City:
State:
Zip Code:
Phone:

VET CONTACT
Name:
Address:
City:
State:
Zip Code:
Phone:
Dog Profile
*Dog's Name:**
Breed:
Color:
Dog's Birth Date: (Month/Day/Year)
Age:
Weight:
Gender:	Male Female
Altered?	Yes No (All dogs over 6 months old must be spayed or neutered.)
*DHLPP (date given):**
*Rabies (date given):**
*Bordatella (date given):**
Medical History and Required Medications:

Special Instructions:

Dietary Allergies:

Is your dog allowed to have treats during the day?
Yes No
Does your dog like to be brushed?
Yes No
Does your dog have any sensitive areas on his or her body that are uncomfortable when touched?
Yes No
If yes, explain:

Does your dog have hip problems?
Yes No
If yes, what restrictions need to be placed on your dog's activities or movements?

Are there any physical problems or disabilities that may affect your dog in daycare?

Length of time you have owned your dog:
Where did you get your dog?
If adopted, do you have any knowledge of your dog's past history?: (If yes, please list or bring that information with you to the evaluation.)

Any other dogs/pets in your household?
Yes No
If yes, number of other pets:
Are they altered?	Yes No
List other dogs' or pets' gender and breed:

Briefly describe how your dog gets along with the other dogs/pets in your home:

What percentage of time does your dog spend
Outside? Inside?
Where is your dog left when you are not at home?


EXERCISE AND PLAY
*Does your dog go on off-leash* walks?** Yes No
How Often? How Far?
*Does your dog go on on-leash* walks?** Yes No
How Often? How Far?
Does your dog play off-leash with other dogs?
Yes No
How Often? How many dogs?
Describe how your dog plays with other dogs? (ex: chase, wrestle, body slam, etc.)

What toys does your dog like:
What games does your dog like to play with people?
Does your dog like to be petted?
Yes No
What is your dogs favorite spot to be petted?
Does your dog get any other exercise regularly?
Yes No
If yes, briefly describe:

Does your dog have experience with agility equipment?
Yes No

BEHAVIOR
How does your dog react when strangers approach your home or yard or out in public?

What does your dog do when a strange dog comes to your home?

What does your dog do when he or she meets a dog while on leash?

What does your dog do when he or she meets a dog while off leash?

Does your dog fence fight?
Yes No
Are there any kinds of people that your dog fears or dislikes?
Yes No
If so, whom?

Are there any kinds of dogs that your dog fears or dislikes?
Yes No
If so, describe:

Is your dog possessive of any toys, food or objects?
Yes No
If yes, explain:

Has your dog ever shared his/her food or toys with other animals?
Yes No
Has your dog ever growled or snapped at anyone taking food or toys away?
Yes No
If yes, explain:

How does your dog react to puppies?

How many fights has your dog gotten into with other dogs?
How many of these fights have resulted in an injury serious enough to require medical attention to the other dog?
Has your dog ever growled or snapped at someone?
Yes No
If yes, what were the circumstances:

How many times has your dog bitten a person?
How many of those bites have required medical attention?
What were the circumstances of the bite?

Has your dog ever climbed over a fence?
Yes No
If yes, how high was the fence?
Has your dog ever dug under a fence?
Yes No
Does your dog have any problems in the following areas? (Check all that apply)
Jumping on people Excessive Chewing Excessive Barking Mouthiness Digging Escaping Stool Eating Housesoiling Pulling on Leash Submissive Urination Separation Anxiety
If yes to any of the above, briefly explain:

Is your dog frightened by any noise?
Yes No
If yes, what?

Is your dog frightened or nervous around anything else?

Is there anything else we should know about your dog?

General Questions
What type of training has your dog had?
No Training Trained Yourself Puppy Class Beginner Obedience Intermediate Obedience Advanced Levels Specialty Classes (ex: rally, agility, freestyle) Private Lessions
What cue words does your dog know? (ex: sit, down, stay, come, etc.)

Is your dog crate trained?
Yes No
Has your dog been in daycare before?
Yes No
What is your main daycare goal for your dog? (ex: socialization, exercise, don't want your dog home alone all day, etc.)

How did you hear about OPPORTUNITY BARKS?
Sign Newspaper Ad Animal Shelter Brochure Internet Search/Website Referral Other
For Referral and Other, list here:
Do we have permission to use photographs of your dog, and/or stories and information about your dog for newspaper articles, websites, flyers and brochures for OPPORTUNITY BARKS?
Yes No

I HAVE READ THE OPPORTUNITY BARKS POLICY & WAIVER DOCUMENTS*

Enter the numbers in the box to the left (required)

Registration Form

Services

Contact Information

Dog Profile

General Questions