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Found/Surrender Dog Application
First Name
*
Last Name
*
eMail Address
*
eMail Address
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Street Address
*
Suite or Unit Number
City
*
State
*
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Phone
*
History
Hidden
Dog Default Status: Submitted
-- select a Status --
Forever Foster
Left Rescue
Denied
Available
Recovery Room
Happy Tails
Over The Bridge
Submitted
Surrendered
Hidden
Are you the legal owner of the dog?
*
Yes
No
Hidden
Please Explain
*
Hidden
Are you the only owner of the dog?
*
Yes
No
Hidden
Please Provide Other Owner's Name:
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Other Owner's Phone #
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When Did You Get The Dog? (approximate if necessary)
Month
Day
Year
Hidden
How Long Have You Had This Dog?
Select Length of Time
Under A Year
1
2
3
4
5
6
7
8
9
10+
How Was The Dog Obtained?
Select Method
Puppy of Current Dog
Shelter
Stray
Private Home
Breeder
Other
Please Explain
Breeder's Name (if Known)
Have They Been Notified?
Yes
No
Why Not?
Owner of Dog's Sire (If Known)
Hidden
Why Are You Giving Up The Dog?
*
Select All That Apply
New Baby
Not Home Enough/Not Enough Time
Found As A Stray
Owner's Health Issues
Dog's Health Issues
New Home
Allergies
Moving & Cannot Take Dog
Behavior Issues
Cannot Afford Care
Other
Hidden
Please Explain
Hidden
Please Explain The Behavior Issues
Hidden
Please Explain The Health Issues
Hidden
Please Explain Care Needed
Hidden
How Many Homes Has This Dog Had?
Select Number
1
2
3
4
5+
Hidden
Veterinarian Information
Hidden
Do You Have a Veterinarian?
Yes
No
Hidden
Name of Clinic
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Name of Vet
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Street Address
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Suite or Unit Number
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City
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State
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Hidden
ZIP
Hidden
Phone
Dog's Name
*
Hidden
Dog's Registered Name (If Purebred)
Hidden
Dog's Registration Number (If Known)
Primary Breed
*
Select Breed
Mix
Mutt
Dad Is the Milkman
Heinz 57
Akbash
Akita Inu
Alaskan Malamute
American Blue Heeler
American Eskimo
Appenzell Mountain Dog
Ausiedoodle
Ausiepoo
Australian Cattle
Australian Kelpie
Australian Shepherd
Azawakh
Basenji
Beagle
Beauceron
Bergamasco
Bernadoodle
Bernese Mountain Dog
Bichon Frisé
Black Mouth Cur
Blue Lacy
Boerboel
Borzoi
Bolognese
Bouvier des Flandres
Boxer
Briard
Brittany
Brussels Griffon
Bulldog
Bulldog - American
Bulldog - English
Bulldog - French
Canaan
Cane Corso
Carolina Dog
Catahoula Leopard Dog
Cattle Dog
Cavapoo
Cheweenie
Chihuahua
Chinese Crested
Chinese Shar-Pei
Chinese Foo Dog
Chinook
Chow Chow
Cirneco dell’Etna
Cockapoo
Collie
Collie - Bearded
Collie - Border
Collie - Rough
Collie - Smooth
Corgi
Corgi - Cardigan Welsh
Corgi - Pembroke Welsh
Coton de Tulear
Dachshund
Dachshund - Miniature
Dachshund - Wirehaired
Dalmatian
Dogo Argentino
Dogue de Bordeaux
Entlebucher Mountain Dog
Eskimo Dog
Feist
Fila Brasileiro
French Bordeaux
Goldendoodle
Great Dane
Great Pyrenees
Greater Swiss Mountain Dog
Hamiltonstovare
Harrier
Havachon
Havamalt
Havana Silk Dog
Havanese
Havapoo
Havashire
Havatzu
Havawart
Hound
Hound - Afghan Hound
Hound - American Coonhound
Hound - American Foxhound
Hound - Basset Hound
Hound - Black and Tan Coonhound
Hound - Bloodhound
Hound - Bluetick Coonhound
Hound - Coonhound
Hound - English Coonhound
Hound - English Foxhound
Hound - Finnish Lapphund
Hound - Foxhound
Hound - Galgo Spanish Greyhound
Hound - Greyhound
Hound - Ibizan
Hound - Irish Wolfhound
Hound - Italian Greyhound
Hound - Keeshond
Hound - Norwegian Buhund
Hound - Norwegian Elkhound
Hound - Norwegian Lundehund
Hound - Otterhound
Hound - Pharaoh Hound
Hound - Plott Hound
Hound - Redbone Coonhound
Hound - Saluki
Hound - Scottish Deerhound
Hound - Swedish Vallhund
Hound - Treeing Walker Coonhound
Husky
Husky - Siberian
Spinone Italiano
Japanese Chin
Jindo
Kai Dog
Karelian Bear Dog
Kishu
Klee Kai
Komondor
Kuvasz
Kyi Leo
Labradoodle
Lancashire Heeler
Leonberger
Lhasa Apso
Lowchen
Malshi
Maltese
Maltipom
Maltipoo
Mastiff
Mastiff - Bull
Mastiff - Neapolitan
Mastiff - Tibetan
McNab
Morkie
Mountain Cur
Mountain Dog
Munsterlander
Native Amer Indian Dog (NAID)
New Guinea Singing Dog
Newfoundland
Papillon
Pekingese
Peruvian Inca Orchid
Petit Basset Griffon Vendéen
Pinscher
Pinscher - Affenpinscher
Pinscher - Doberman
Pinscher - German
Pinscher - Miniature
Portuguese Podengo
Pointer
Pointer - English
Pointer - German Shorthaired
Pointer - German Wirehaired
Pointer - Wirehaired Pointing Griffon
Pomeranian
Poodle
Poodle - Miniature
Poodle - Standard
Poodle - Teacup
Poodle – Toy
Presa Canario
Pequeno
Portuguese Water Dog
Pug
Puli
Pumi
Retriever
Retriever - Black Labrador
Retriever - Chesapeake Bay
Retriever - Chocolate Labrador
Retriever - Curly-Coated
Retriever - Flat Coated
Retriever - Golden
Retriever - Labrador
Retriever - Nova Scotia Duck Tolling
Retriever - Yellow Labrador
Rhodesian Ridgeback
Rottweiler
Saint Bernard
Samoyed
Sarplaninac
Schipperke
Schnauzer
Schnauzer - Giant
Schnauzer - Miniature
Schnauzer - Standard
Setter
Setter - English
Setter - Gordon
Setter - Irish
Shar-Pei
Sheepdog
Sheepdog - Belgian
Sheepdog - Caucasian (Ovtcharka)
Sheepdog - Icelandic
Sheepdog - Illyrian
Sheepdog - Maremma
Sheepdog - Old English
Sheepdog - Polish Lowland
Sheepdog - South Russian Ovtcharka
Sheepdog - Shetland
Shepherd
Shepherd - Anatolian Dog
Shepherd - Australian
Shepherd - Belgian Laekenois
Shepherd - Belgian Malinois
Shepherd - Belgian Tervuren
Shepherd - Dutch
Shepherd - English
Shepherd - German
Shepherd - Pyrenean
Shepherd - White German
Shiba Inu
Shihpoo
Shih Tzu
Shorkie
Sloughi
Spaniel
Spaniel – American Cocker
Spaniel - American Water
Spaniel - Boykin
Spaniel - Brittany
Spaniel - Cavalier King Charles
Spaniel - Clumber
Spaniel – English Cocker
Spaniel - English Toy
Spaniel - Field
Spaniel - Irish Water
Spaniel - English Springer
Spaniel - Springer
Spaniel - Sussex
Spaniel - Welsh Springer
Spaniel - Tibetan
Spanish Water Dog
Spitz
Spitz - Finnish
Spitz - German
Terrier
Terrier - Airedale
Terrier - American Hairless
Terrier - American Pit Bull
Terrier - American Staffordshire
Terrier - Australian
Terrier - Bedlington
Terrier - Biewer
Terrier - Black Russian
Terrier - Boston
Terrier - Border
Terrier - Bull
Terrier - Cairn
Terrier - Cesky
Terrier - Dandie Dinmont
Terrier - Fox
Terrier - Glen of Imaal
Terrier - Irish
Terrier - Jack Russell
Terrier - Kerry Blue
Terrier - Lakeland
Terrier - Manchester
Terrier - Miniature Bull
Terrier - Norfolk
Terrier - Norwich
Terrier - Parson Russell
Terrier - Patterdale / Fell
Terrier - Rat
Terrier - Scottish
Terrier - Sealyham
Terrier - Smooth Fox
Terrier - Silky
Terrier - Skye
Terrier - Staffordshire Bull
Terrier - Tibetan
Terrier - Toy Fox
Terrier - Toy Manchester
Terrier - Welsh
Terrier - West Highland White (Westie)
Terrier - Soft Coated Wheaten
Terrier - Wire Fox
Terrier - Wirehaired
Terrier - Yorkshire (Yorkie)
Thai Ridgeback
Tosa Inu
Vizsla
Weimaraner
Whippet
Yorkiepoo
Xoloitzcuintli
Breed Name
Secondary Breed
Select Breed
Mix
Mutt
Dad Is the Milkman
Heinz 57
Akbash
Akita Inu
Alaskan Malamute
American Blue Heeler
American Eskimo
Appenzell Mountain Dog
Ausiedoodle
Ausiepoo
Australian Cattle
Australian Kelpie
Australian Shepherd
Azawakh
Basenji
Beagle
Beauceron
Bergamasco
Bernadoodle
Bernese Mountain Dog
Bichon Frisé
Black Mouth Cur
Blue Lacy
Boerboel
Borzoi
Bolognese
Bouvier des Flandres
Boxer
Briard
Brittany
Brussels Griffon
Bulldog
Bulldog - American
Bulldog - English
Bulldog - French
Canaan
Cane Corso
Carolina Dog
Catahoula Leopard Dog
Cattle Dog
Cavapoo
Cheweenie
Chihuahua
Chinese Crested
Chinese Shar-Pei
Chinese Foo Dog
Chinook
Chow Chow
Cirneco dell’Etna
Cockapoo
Collie
Collie - Bearded
Collie - Border
Collie - Rough
Collie - Smooth
Corgi
Corgi - Cardigan Welsh
Corgi - Pembroke Welsh
Coton de Tulear
Dachshund
Dachshund - Miniature
Dachshund - Wirehaired
Dalmatian
Dogo Argentino
Dogue de Bordeaux
Entlebucher Mountain Dog
Eskimo Dog
Feist
Fila Brasileiro
French Bordeaux
Goldendoodle
Great Dane
Great Pyrenees
Greater Swiss Mountain Dog
Hamiltonstovare
Harrier
Havachon
Havamalt
Havana Silk Dog
Havanese
Havapoo
Havashire
Havatzu
Havawart
Hound
Hound - Afghan Hound
Hound - American Coonhound
Hound - American Foxhound
Hound - Basset Hound
Hound - Black and Tan Coonhound
Hound - Bloodhound
Hound - Bluetick Coonhound
Hound - Coonhound
Hound - English Coonhound
Hound - English Foxhound
Hound - Finnish Lapphund
Hound - Foxhound
Hound - Galgo Spanish Greyhound
Hound - Greyhound
Hound - Ibizan
Hound - Irish Wolfhound
Hound - Italian Greyhound
Hound - Keeshond
Hound - Norwegian Buhund
Hound - Norwegian Elkhound
Hound - Norwegian Lundehund
Hound - Otterhound
Hound - Pharaoh Hound
Hound - Plott Hound
Hound - Redbone Coonhound
Hound - Saluki
Hound - Scottish Deerhound
Hound - Swedish Vallhund
Hound - Treeing Walker Coonhound
Husky
Husky - Siberian
Spinone Italiano
Japanese Chin
Jindo
Kai Dog
Karelian Bear Dog
Kishu
Klee Kai
Komondor
Kuvasz
Kyi Leo
Labradoodle
Lancashire Heeler
Leonberger
Lhasa Apso
Lowchen
Malshi
Maltese
Maltipom
Maltipoo
Mastiff
Mastiff - Bull
Mastiff - Neapolitan
Mastiff - Tibetan
McNab
Morkie
Mountain Cur
Mountain Dog
Munsterlander
Native Amer Indian Dog (NAID)
New Guinea Singing Dog
Newfoundland
Papillon
Pekingese
Peruvian Inca Orchid
Petit Basset Griffon Vendéen
Pinscher
Pinscher - Affenpinscher
Pinscher - Doberman
Pinscher - German
Pinscher - Miniature
Portuguese Podengo
Pointer
Pointer - English
Pointer - German Shorthaired
Pointer - German Wirehaired
Pointer - Wirehaired Pointing Griffon
Pomeranian
Poodle
Poodle - Miniature
Poodle - Standard
Poodle - Teacup
Poodle – Toy
Presa Canario
Pequeno
Portuguese Water Dog
Pug
Puli
Pumi
Retriever
Retriever - Black Labrador
Retriever - Chesapeake Bay
Retriever - Chocolate Labrador
Retriever - Curly-Coated
Retriever - Flat Coated
Retriever - Golden
Retriever - Labrador
Retriever - Nova Scotia Duck Tolling
Retriever - Yellow Labrador
Rhodesian Ridgeback
Rottweiler
Saint Bernard
Samoyed
Sarplaninac
Schipperke
Schnauzer
Schnauzer - Giant
Schnauzer - Miniature
Schnauzer - Standard
Setter
Setter - English
Setter - Gordon
Setter - Irish
Shar-Pei
Sheepdog
Sheepdog - Belgian
Sheepdog - Caucasian (Ovtcharka)
Sheepdog - Icelandic
Sheepdog - Illyrian
Sheepdog - Maremma
Sheepdog - Old English
Sheepdog - Polish Lowland
Sheepdog - South Russian Ovtcharka
Sheepdog - Shetland
Shepherd
Shepherd - Anatolian Dog
Shepherd - Australian
Shepherd - Belgian Laekenois
Shepherd - Belgian Malinois
Shepherd - Belgian Tervuren
Shepherd - Dutch
Shepherd - English
Shepherd - German
Shepherd - Pyrenean
Shepherd - White German
Shiba Inu
Shihpoo
Shih Tzu
Shorkie
Sloughi
Spaniel
Spaniel – American Cocker
Spaniel - American Water
Spaniel - Boykin
Spaniel - Brittany
Spaniel - Cavalier King Charles
Spaniel - Clumber
Spaniel – English Cocker
Spaniel - English Toy
Spaniel - Field
Spaniel - Irish Water
Spaniel - English Springer
Spaniel - Springer
Spaniel - Sussex
Spaniel - Welsh Springer
Spaniel - Tibetan
Spanish Water Dog
Spitz
Spitz - Finnish
Spitz - German
Terrier
Terrier - Airedale
Terrier - American Hairless
Terrier - American Pit Bull
Terrier - American Staffordshire
Terrier - Australian
Terrier - Bedlington
Terrier - Biewer
Terrier - Black Russian
Terrier - Boston
Terrier - Border
Terrier - Bull
Terrier - Cairn
Terrier - Cesky
Terrier - Dandie Dinmont
Terrier - Fox
Terrier - Glen of Imaal
Terrier - Irish
Terrier - Jack Russell
Terrier - Kerry Blue
Terrier - Lakeland
Terrier - Manchester
Terrier - Miniature Bull
Terrier - Norfolk
Terrier - Norwich
Terrier - Parson Russell
Terrier - Patterdale / Fell
Terrier - Rat
Terrier - Scottish
Terrier - Sealyham
Terrier - Smooth Fox
Terrier - Silky
Terrier - Skye
Terrier - Staffordshire Bull
Terrier - Tibetan
Terrier - Toy Fox
Terrier - Toy Manchester
Terrier - Welsh
Terrier - West Highland White (Westie)
Terrier - Soft Coated Wheaten
Terrier - Wire Fox
Terrier - Wirehaired
Terrier - Yorkshire (Yorkie)
Thai Ridgeback
Tosa Inu
Vizsla
Weimaraner
Whippet
Yorkiepoo
Xoloitzcuintli
Breed Name
Hidden
Primary Color
Select Color
Apricot
Beige
Black
Blue
Brown
Buff
Chestnut
Chocolate
Cream
Fawn
Grey
Gold
Liver
Orange
Red
Ruby
Rust
Silver
Tan
Wheaten
White
Yellow
Black and Tan
Black and White
Blue and Tan
Blue and White
Brown and Tan
Brown and White
Buff and White
Chocolate and Tan
Chocolate and White
Liver and Tan
Red and White
Silver and Cream
White and Cream
Blenheim
Brindle
Flecked Ticked or Spotted
Harlequin
Hairless
Merle-Blue
Merle-Red
Particolor
Roan
Sable
Saddle or Blanket
Tri Color
Tuxedo
Hidden
Which Color?
*
Hidden
Secondary Color
Select Color
Apricot
Beige
Black
Blue
Brown
Buff
Chestnut
Chocolate
Cream
Fawn
Grey
Gold
Liver
Orange
Red
Ruby
Rust
Silver
Tan
Wheaten
White
Yellow
Black and Tan
Black and White
Blue and Tan
Blue and White
Brown and Tan
Brown and White
Buff and White
Chocolate and Tan
Chocolate and White
Liver and Tan
Red and White
Silver and Cream
White and Cream
Blenheim
Brindle
Flecked Ticked or Spotted
Harlequin
Hairless
Merle-Blue
Merle-Red
Particolor
Roan
Sable
Saddle or Blanket
Tri Color
Tuxedo
Hidden
Which Color?
*
Gender
*
Male
Female
Dog's Date of Birth (If Known)
MM slash DD slash YYYY
Weight
*
Select Weight
1 Pound
2 Pounds
3 Pounds
4 Pounds
5 Pounds
6 Pounds
7 Pounds
8 Pounds
9 Pounds
10 - 20 Pounds
21 - 30 Pounds
31 - 40 Pounds
41 - 50 Pounds
51 - 60 Pounds
61 - 70 Pounds
71 - 80 Pounds
81 - 90 Pounds
91 - 100 Pounds
Over 100 Pounds
Energy Level
*
Select Energy Level
Active and Playful
Affectionate
Couch Potato
Gentle and Friendly
Happy
High Energy
Intelligent
Playful & Inquisitive
Good With Kids?
*
Select Option
I Like All Kids
I Like Kids Over 6
I Like Kids Over 10
I Don't Like Kids
I Have Not Been Tested with Kids
Good With Dogs?
*
Select Option
I Like All Dogs
I Only Like Small Dogs
I Only Like Big Dogs
I Like Select Dogs
I Don't Like Dogs
I Have Not Been Tested with Dogs
Please Explain
*
Good With Cats?
*
Select Option
I Like All Cats
I Like Some Cats
I Don't Like Cats
I Have Not Been Tested with Cats
Hidden
Good With Small Animals?
Select Option
I Like All Small Animals
I Like Some Small Animals
I Don't Like Small Animals
I Have Not Been Tested with Small Animals
Hidden
Good With Livestock?
Select Option
I Am Good with Livestock
I Am Scared of Livestock
I Am Aggressive with Livestock
I Have Not Been Tested with Livestock
Is Dog Trained?
Select Option
I'm Trained
I'm Currently In Training
I'm Not Trained Yet
Hidden
Are There Any Special Needs?
Yes
No
Hidden
What Special Needs?
Blind
Deaf
Doesn't Walk Well
Medical Condition
Select All That Apply
Hidden
Description of the Dog
Featured Image
Accepted file types: jpg, jpeg, png, gif.
750 Wide x 750 High in Pixels
Additional Photos of The Dog
Drop files here or
Select files
Accepted file types: jpg, gif, png, jpeg, Max. file size: 1 MB, Max. files: 3.
Upload Photos of the Dog (minimum of 3 - include one head shot, one full body) and 750 Wide x 750 High in Pixels
Hidden
Eating
Hidden
How Often Is The Dog Fed?
Select Option
Once (Morning)
Once (Afternoon)
Once (Evening)
Twice (Morning & Evening)
Hidden
Does Dog Eat Wet Or Dry Food (Or Both)?
Select Option
Wet
Dry
Both
Hidden
What Type Of Wet Food Does The Dog Eat?
*
Hidden
How Much Wet Food Does The Dog Eat?
*
Hidden
What Type Of Dry Food Does The Dog Eat?
*
Hidden
How Much Dry Food Does The Dog Eat?
*
Hidden
What Type Of Wet Food Does The Dog Eat?
*
Hidden
How Much Wet Food Does The Dog Eat?
*
Hidden
What Type Of Dry Food Does The Dog Eat?
*
Hidden
How Much Dry Food Does The Dog Eat?
*
Hidden
Is Dog A Good Eater?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Steal Food From Table/Counters?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Sleeping
Hidden
Which Room Does Dog Normally Sleep In At Night?
Any Room He/She Wants
In Adult's Room
In Kid's Room
Family/Living Room or Den
Garage
Outside
Other
Select All That Apply
Hidden
Please Describe
*
Hidden
What Does Dog Use For A Bed?
Crate
Dog Bed
Human Bed
Sofa/Chair/Furniture
Other
Select All That Apply
Hidden
Please Describe
*
Hidden
Is Dog Allowed On Furniture?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Grooming
Hidden
How Often is Dog Bathed?
Select Option
Weekly
Every Other Week
Monthly
Hidden
Does Dog Mind Baths/Grooming
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Mind Toenails Clipped
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Mind Ears Cleaned
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Dog & People
Hidden
Is Dog A One Person Dog?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Like Men?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Explain
*
Hidden
Please Explain
*
Does Dog Like Women?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Explain
*
Please Explain
*
Hidden
Does Dog Prefer Men?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Please Explain
*
Hidden
Does Dog Prefer Women?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Please Explain
*
Hidden
Does Dog Jump On People?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Is Dog Friendly With Strangers?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Is Dog Good With Other Animals?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Is Dog Good With Kids?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Like Kids Under 6?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Like Kids 6-10?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Like Kids Over 10?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Dog's Temperament
Friendly
Playful
Dominant
Fearful
Shy
Mellow
Active
Aggressive
Select All That Apply
Hidden
How Are Dog's Social Skills?
Plays with Dogs
Has Selective Dog Friends
Plays at Doggie Daycare
Plays at Dog Beach
Select All That Apply
Training
Hidden
Does Dog Know Basic Commands?
Sit
Stay
Down
Off
Heel
Come
Leave It
All Of The Above
None Of The Above
Select All That Apply
Hidden
Is Dog Obedience Trained?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Is Dog House Trained?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Is Dog Crate Trained?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Hidden
Is Dog Leash Trained?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Hidden
How Does Dog React on Walks?
Well Mannered
Pulls on Leash
Likes Other Dogs
Happy to See People (Strangers)
OK with Distractions (Bikes, Skateboards)
Doesn't Likes Other Dogs
Lunges at Other Dogs
Isn't Happy to See People (Strangers)
Doesn't Like Distractions (Bikes, Skateboards)
Drags Walker
Select All That Apply
Hidden
Does Dog Know How To Use A Doggie Door?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Hidden
Does Dog Have Occasional Accidents?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Tear/Chew Furniture Or Carpet?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Can Dog Be Left Uncrated?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Dig?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Know How To Swim?
Select Option
Yes, Loves It
Yes, Doesn't Like It
Some Or Sometimes
Not Tested/Not Sure
No
Hidden
Does Dog Jump Fences?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Escape?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Ride Well In The Car?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Barking
Hidden
Does Dog Bark At Noises?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Bark At Someone At The Door?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Does Dog Bark Excessively?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Fear & Agression
Hidden
Does Dog Exhibit Submissive Behavior?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Please Describe
*
Hidden
Please Describe
*
Hidden
Does Dog Exhibit Aggressive Behavior?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Please Describe
*
Hidden
Please Describe
*
Hidden
Does Dog Guard Food?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Please Describe
*
Hidden
Please Describe
*
Hidden
Does Dog Guard Other Resources (Toys, People, etc.)?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Please Describe
*
Hidden
Please Describe
*
Hidden
Is Dog Shy?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Please Describe
*
Hidden
Please Describe
*
Hidden
Is Dog Fearful Of Strange Noises/Storms?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Hidden
Please Describe
*
Hidden
Please Describe
*
Hidden
Has Dog Ever Bitten Anyone?
Select Option
Yes
No
Unknown
Hidden
Please Explain
*
Hidden
Has Dog Otherwise Attacked Anyone?
Select Option
Yes
No
Unknown
Hidden
Please Explain
*
Hidden
Has Dog Attacked Another Animal (Dog, Cat or Other)?
Select Option
Yes
No
Unknown
Hidden
Please Explain
*
Hidden
Is there anything else you would like to let us know about the dog's disposition?
Hidden
Medical: MicroChip Information
Hidden
Is Dog MicroChipped
Select Option
Yes
No
Unknown
Hidden
Are you prepared to transfer registration to {RescueName} on or prior to the surrender of the dog?
Yes
No
Hidden
MicroChip Company (If Known)?
Select Company
24Pet Watch
AKC
AVID
Found Animals
Home Again
Nano
Pet Link
Smart Tase
Other
Hidden
Other Company
Hidden
MicroChip Number (If Known)?
Hidden
Does Dog Have a Tattoo?
Select Option
Yes
No
Unknown
Hidden
Please Upload Photo
*
Drop files here or
Select files
Accepted file types: jpg, gif, png, jpeg, Max. file size: 5 MB, Max. files: 3.
Hidden
Please Describe
*
Hidden
Medical: Medical Conditions
Hidden
Add Current Medical Conditions (N Number)
Hidden
Add Past Medical Conditions (N Number)
Medical: Status
Is Dog Spayed Or Neutered?
Yes
No
Hidden
Date:
*
Month
Day
Year
Hidden
Expected Date
*
Month
Day
Year
Hidden
Please Explain Why Not
*
Hidden
Medical: Dental Conditions
Hidden
Add Current Dental Conditions (N Number)
Hidden
Add Past Dental Conditions (N Number)
Hidden
Medical: Known Allergies
Hidden
Add Allergies (N Number)
Hidden
Medical: Medicines
Hidden
Add Medications (N Number)
Notes
Is there anything else you would like to let us know?
In your opinion, what would be the best type of home situation for this dog?
This contract is between (current owner) and Summit's Sanctuary (SSAR) (New Owners described above, and is made for the benefit and protection of both the current owner and the new owners as well as the welfare of the dog. The current owner herby relinquishes all claim of ownership of, and responsibility for, the above mentioned dog. No guarantee of health has been given to new owner by the current owner, and the new owner agrees to hold the current owner harmless for any veterinary or other expenditures that may arise after this date. All transactions relating to the surrender of this dog shall be held confidential by Summit's Sanctuary. This agreement shall be construed under that laws of, and enforced only in the courts of, Alabama. In signing this agreement, the sigher or signers of this document agree to its terms and shall reimburse to Summits Sanctuary the reasonable legal fees and costs associated with any legal action necessary to enforce this agreement. This means that any lawsuit filed in relation to this contract must be filed and tried within Alabama, regardless of the geographic location of the other party. Current owner signature. I agree and submit that all of the above information is true to the best of my knowledge.
*
Yes
Signature
Phone
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