| Name * |
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| E-mail Address * |
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| Address * |
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| City * |
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| Zip Code * |
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| Home Phone Number * |
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| Cell Phone Number * |
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| Name of your dog * |
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| Breed or Primary Breed Mix * |
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| Aproximate age of dog * |
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| Apriximate size of dog (in pounds) * |
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| Sex of your dog * |
Male
Female
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| Spayed or Neutered? * |
Yes
No
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| Is your dog potty trained? * |
Yes
No
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| Why are you giving up your dog? Please be specific... * |
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| Are you the legal owner of this dog? * |
Yes
No
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| If not, please explain... |
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| Is your dog good with cats? * |
Yes
No
Unknown
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| Has your dog been living with children? * |
Yes
No
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| If yes, what ages? |
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| Is your dog good with women? * |
Yes
No
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| Is your dog good with men? * |
Yes
No
Some
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| How is your dog when he/she meets strangers? * |
Friendly
Timid/Shy
Aggressive
Obnoxious
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| Is your dog good with other dogs? * |
Yes
No
Some
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| Where was your dog obtained? * |
Rescue
Friend
Pet Shop
Pound/Shelter
Breeder
Gift
Other
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| If rescue, which one? |
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| If other, please explain... |
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| How long have you had your dog? * |
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| Does your dog have ANY health issues? * |
Yes
No
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| If yes, please explain...Please also include current treatment. * |
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| Has your dog been an... * |
Indoor Pet
Outdoor Pet
Indoor/Outdoor Pet
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| Your dog eats... * |
Dry Food Only
Wet Food Only
Dry/Wet Both
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| Brand of Dog Food * |
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| Quantity of food and how often? * |
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| Is your dog crate trained? * |
Yes
No
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| Where does your dog currently sleep? * |
Bed with you
Outside
In garage
Where he/she wants in the house
Crate
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| How much time does your dog spend alone during the day? * |
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| Is your dog destructive when left in the house, alone? * |
Yes
No
Sometimes
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| Where does your dog stay when you are not home? * |
Inside
Outside
Indoors/Outdoors (Doggie Door)
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| Does your dog have any separation anxiety? * |
Yes
No
Sometimes
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| If "yes" or "sometimes", please elaborate and give details. |
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| When left alone, does your dog... * |
Doesn't care
Whines/Cries
Barks/Howls
Destructive
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| What games does your dog enjoying playing? * |
Frisbee
Fetch
Tag
Tug-o-War
Ball
None: Couch Potato
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| Has your dog ever bitten or shown any aggressive tendencies: * |
Yes
No
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| If yes, to whom, and under what circumstances (please be honest, you will be liable if this dog is placed and bites someone and you were aware that the dog had a history of biting) |
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| Is your dog possessive of toys, food, or his/her people: * |
Yes
No
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| How does your dog react if you approach his toys, food, etc.: * |
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| Has your dog had obedience training, even a basic class: * |
Yes
No
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| How does your dog respond to commands: * |
Excellent
Good
Fair
Poor
When HE/SHE wants to...
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| What is the best way to get your dog to listen/obey: * |
Praise
Treat
Correction
Firm Voice
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| Are you able to foster your dog until a new home can be found? * |
Yes
No
Possibly, depends on time frame.
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| If "yes" or "possibly", please give us the latest date you can keep the dog... |
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| All statements made above are truthful to the best of my knowledge. I understand that I may retain liability if I have knowingly misstated the truth about my dog and he causes injury to humans, other animals, or property. I also understand that I am not entitled to any form of compensation for this dog. * |
Accept
Do not accept
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| I understand that Love 4 Canines will need the following upon transfer of dog:A copy of dog's medical records, including spay/neuter certificate, rabies certificate, and proof of current DHLPP shot. * |
Yes
No
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