| NOTE: Please keep your answers brief, with a limit of 500 characters per answer |
*First Name:
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*Last Name:
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*Address:
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*City:
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*State:
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*Postal Code:
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Email:
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| Home Phone: |
Work Phone: |
| Cell Phone: |
Best Time to Call: |
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| Is this dog a purebred? |
Call name: |
| Birth date: |
Age: |
| Dog's Registered Name: |
Color: |
| Weight: |
Gender: |
| Tail Docked? |
Dog Spay/neutered? |
| Housebroken? |
Crate Trained? |
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| How long have you owned this dog? |
Is the dog co-owned? (If yes, you must provide signed release) |
| Are any registration papers available? LEP# or ILP# |
Will you provide these to the new owner? |
| Was the dog bought from a breeder? |
If yes, give name: |
| Have you notified the breeder about the need to find the dog a new home? |
What was the breeder's response? |
| Did you sign a contract with the breeder? |
Did the contract require you to offer the breeder the dog before you release your ownership of the dog? |
| Was the dog bought from a pet store? |
If yes, give name: |
| Was the dog adopted from a shelter? |
If yes, give name: |
| Does the shelter adoption agreement require that the dog be returned to them? |
How did you acquire your dog if not from one of the above sources? |
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| Dog's veterinarian of record: |
Vet Phone Number: |
| Are the dog's shots up to date? |
Is the dog on flea/tick preventative? |
| Date of last rabies shot? |
Date of last DHLPP? |
| Has the dog been HeartWorm tested? |
Is it on HeartWorm preventative? |
| Date of last fecal/worming: |
List any other vaccinations/treatments: |
| Does dog have any physical problems? |
Allergies: |
| On medication: |
What kind? |
| If unspayed female, when was the last heat cycle? |
Is there any possibility dog might be pregnant? |
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| Has the dog had any obedience classes? |
Did you complete the class? |
| What age was the dog at the time? |
Any other training? Tracking? Agility? Herding? Guard? Other? |
| List commands, tricks, skills: |
| Does the dog stay in a fenced yard? Indoors? Basement? Garage? Loose Outside? Tied up? Kennel Run? Other? |
| Where does the dog spend most of his time? |
What other animals has this dog lived with: |
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| How does the dog react to: Other dogs; Strangers; Men; Children; Cats; Other Animals; Alone in the house; Alone in car; Alone in yard; Walking on lead; |
| Does the dog have the following habits? If yes, please describe: Excessive barking? Jumps Fence? Destructive Chewing? Aggressive? Shy? Digs? Fights with other dogs? |
| Has the dog killed or chased other animals? |
If so, describe: |
| Has the dog ever bitten a person? |
If so, describe: |
| Was bite reported to city or county animal control? |
What brought on this bite? |
| Was the dog quarantined? |
Does dog growl when you take away its food or toys? |
| Does the dog snap or nip at people? |
What causes this kind of behavior? |
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| Why do you want to place your dog for adoption? |
Have you tried to place the dog yourself? |
| What is the most appealing thing about your dog? |
What activities/things does your dog like best? Dislike? Fear? |
| What is its biggest fault? |
Do you understand that all dogs we place must be spayed or neutered? |