Profile & Background Can you provide proof of legal ownership?
Reason you are considering surrender
Rabies Tag/Certificate Available?
Name and Location you acquired this dog from:
Describe dog’s history prior to your ownership:
Are clinic records available?
*note – you may need to call the clinic to authorize the release of records
Please list current medications, supplements and any health issues or injuries for this dog.
Has the dog’s residence changed in the past year?
Does this dog have access to a fenced yard?
Has this dog ever jumped over a fence?
If no fence, how has this dog been exercised and/or kept in the yard?
Is this dog allowed on furniture?
Do you have concerns with this dog meeting new adults? If so, please explain:
Do you have concerns with this dog meeting new children? If so, please explain:
Do you have concerns with this dog meeting/interacting with other dogs or cats? If so, please explain:
Does this dog walk easily on leash
Select words or phrases this dog responds to:
Which characteristics apply to this dog?
What do you like best about this dog?
Summarize this dog’s overall temperament. (ex – mellow, dominant, clingy, submissive, happy, active, high-strung, shy, anxious, fearful, jealous, protective, playful, silly, affectionate)
Do you have any other information or comments, we may have missed in the above, that you feel will help us find a good home for this dog?
Has this dog every bitten another animal?
Has this dog every bitten a person?
If you said yes to either bite question, please explain what happen:
Please explain any complaints from neighbors, or citations, orders, or complaints from Animal Control or Law Enforcement involving this dog:
Let us know what, if any, equipment and or supplies will accompany this dog at transfer. (ex- collar, leash, bed, blanket, toys, crate, medication, food, treats, …) (monetary donations are always appreciated)
Are you able to help transport to one of our volunteers?
Submit