| 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? |
| Dog's name: |
Sex: |
| Birth date: |
Age: |
| Color: |
Weight: |
| Dog Spay/Neutered? |
Tail Docked? |
| Housebroken? |
Crate Trained? |
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| How long have you owned this dog? |
Dog's Breeder: |
| Are any registration papers available? LEP# or ILP# |
Dog's Registered Name, if available: |
| If yes, will you provide these to the new owner? |
Did you sign a contract requiring you to return your dog to the breeder/shelter/private party that you obtained him/her from? |
| How did you acquire your dog? |
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| Dog's Veterinarian: |
Vet Phone Number: |
| Are health records available? |
If yes, under what name? |
| Has the dog been Heartworm tested? |
Is it on Heartworm Preventative? |
| Does dog have any physical problems? |
Does the dog have an allergies? |
Is the dog on any medications?
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If so, what kind?
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| Where does the dog stay during the day? |
| Where does the dog stay during the night? |
| List commands, tricks, skills, etc: |
| What other animals has this dog lived with? |
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| Does the dog have any of the following habits?
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Other Habits?
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| 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? |
Was the dog quarantined? |
| 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? |
| What is the most appealing thing about your dog? |
| What is its biggest fault? |
| Do you understand that all dogs we place must be spayed or neutered? |