Application Your Information Your Name * Address * Country * United States Address 1 * Address 2 City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code * Home Phone Cell Phone * Work Phone Email * Emergency Contact Information Emergency Contact - Other than yourself * Emergency Contact Home Phone * Emergency Contact Cell Phone * Emergency Contact Work Phone * Emergency Contact Email * Veterinarian Veterinarian * Veterinarian Address * Country * United States Address 1 * Address 2 City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code * Veterinarian Phone Number Describe Other Pet Information Pet Name * Pet Sex * Male Female Spayed/Neutered? * Yes No Age * Birth date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Breed * Color * Weight * Who can pick up the dog? * Pet 2 (If Applicable) Name Sex Male Female Spayed/Neutered? Yes No Age Birth date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Breed Color Weight Pet 3 (If Applicable) Pet Name 3 Pet Sex Male Female Spayed/Neutered? Yes No Age Birth Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Breed Color Weight Pet 4 (If Applicable) Name Sex Male Female Spayed/Neutered? Yes No Age Birth date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Breed Color Weight Feeding Schedule * Brand and Type of Food * We use Taste of the Wild dry kibble as a reward. Is your dog allowed to have treats? * Yes No Has your dog ever shown signs of food aggression or guarding? * Yes No Please describe Does your dog have any allergies? * Yes No Please describe How did you acquire your dog? * How long have you had your dog? * Dog Temperament * Dog Reactions * At home? * On neutral territory? * On lead? * Has your dog ever been boarded or to daycare before? * Yes No Where did they attend? How did they do? Describe your dog's play style * Does your dog have any behavioral issues? * How does your dog react to strangers? * Has your dog ever bitten a human? * Yes No Describe the incident and include date, cause, and injuries if any Does your dog prefer a particular sex of dog? * Yes No Please describe Are there any types of dogs your dog is reactive or fearful of? * Yes No Explain in detail Does your dog(s) have any kinds of dog that they automatically fears or dislikes? * Yes No Please Describe Has your dog ever been in a fight or bitten another dog? * Yes No Please describe the incident and include date, cause, and injuries if any Does your dog have any behavioral quirks? (for example, being vocal while being pet) * Yes No Please Describe Has your dog(s) ever escaped or attempted to escape by digging or jumping/climbing fences? * Yes No Please Describe Does your dog jump on people? * Yes No Please Describe Do you walk your dog(s)? * Yes No How often? What distance? What other exercise does your dog(s) receive? * How often? Does your dog(s) have a circumstance or situation that they are frightened of? * Yes No Describe Describe how you would calm the dog(s) during this situation Is your dog(s) housebroken or crate trained? * Does your dog(s) play with toys? Yes No What kind? Is your dog possessive? * Yes No Please describe Has your dog(s) shared toys/food/water with other dogs before? * Yes No Were there any problems? Does your dog have any exercise restrictions? * Yes No Please describe Has your dog(s) ever played on playground or agility equipment before? Yes No Do you feel that play equipment would be inappropriate for your dog(s)? * Yes No Please describe Has your dog(s) ever received any formal training? * Yes No Where and when? Does your dog know any commands? * Yes No Please describe What do you do with your dog when you leave the home? * How does your dog react when you get home? Does your dog have any health concerns that you are aware of? (Medical conditions, illnesses, recent surgeries or injuries, physical limitations) * Yes No please_describe Is your dog currently on any medication? * Yes No Please describe Does your dog(s) like to receive brushings? Yes No How often are they brushed? How does your dog(s) react to getting his/her/their nails clipped? * Does your dog(s) have any areas on their body that they do not like to be touched? * Yes No Please describe Does your dog have a special place that your dog likes to be petted or rubbed? Yes No Please describe Brand Does your dog receive flea and tick preventative? * Yes No Frequency Type Is there anything else that you believe we should know about your dog? * What are your goals for your dog while attending MPA? When would you like to start? * If boarding, what dates are you interested in boarding your dog? Upload Vaccines Files must be less than 10 MB.Allowed file types: gif jpg jpeg png pdf zip. I have read the Mutty Paws Academy handbook and agree to its policies I have read the handbook and agree to its policies * Yes Signature Of Owner * How Did You Hear About Us? * How Did You Hear About Us?AdvertisementExisting OwnerGoogleNewspaperRadioTrainerVeterinarianWalk-inWebsiteWord of mouthYahooOther
