Dog Owner Questionnaire

Size: px
Start display at page:

Download "Dog Owner Questionnaire"

Transcription

1 Dog Owner Questionnaire 2070 Griffin Road Fort Lauderdale, FL Dogs can t talk, so they can t tell us where or whom they would like to live. To ensure that their home is a safe, happy and appropriate place for your dog to live, we need you to fill out this form in as much detail as possible. Detail and honest information from you is crucial to our placement process, so please take the time to fill in this profile with care and accuracy. Undesirable behaviors and medical issues do not necessarily create problems in placement, however, not disclosing those problems definitely does. Dishonest or incomplete responses can undermine the safety and happiness of both your dog and the new adopting family. If there are any questions that are unclear or that you are uncomfortable responding to for any reason, please ask to speak directly to one of our helpful staff members about the issue. Owner s Name Address City State Zip County Phone number Alternate Phone number address How did you hear about the Humane Society of Broward County s Surrender by Appointment Services? GENERAL ANIMAL INFORMATION ANIMAL ID (for clinic use only) (check the correct answer when applicable) Dog s Name: Dog s age or approximate age: Breed of Dog: Dog s Sex: Male Female Unsure 1. Is your dog spayed/neutered? Yes No Unsure

2 2. What kind of I.D. does your dog have (tattoo or microchip)? Tattoo (If so, where is it located) Microchip # 3. Is this I.D. registered in your name? Yes No If no, who is the I.D. registered to? HISTORY 1. Why are you surrendering your dog? 2. If surrender reason is behavioral, please explain: 3. If we could help you resolve this issue would you be interested in keeping the dog? 4. Have you tried to find a home for this dog on your own? Yes No If yes, how did you go about this? 5. Have you contacted breed-specific rescue groups for help in re-homing your dog? Yes No 6. How long have you owned your dog? 7. Including yours, how many homes has your dog had? 8. Where did you acquire this dog?(check best answer) From Humane Society of Broward Another shelter Breeder Found as a stray Newspaper/Internet Ad Friend/relative Pet Store Born in my home Other LIFESTYLE AND HOME LIFE 1. Has this dog lived with other dogs? If yes, how did they interact? 2. How is your dog s behavior around dogs it is not familiar with? (check all that apply) Aggressive with all dogs Bossy Frightened Ignores or is indifferent Gentle/Submissive Roughhouses Aggressive with

3 same sex dogs Other: 3. Would you recommend placing this dog in a home with other dogs? Yes No If no, please explain: 4. Has this dog lived with cats? Yes No If yes, how did they interact? 5. Did the dog need supervision with the cat at first? Yes No 6. How does the dog react to cats outside of its home that are unfamiliar? 7. Would you recommend placing this dog in a home with cats? Yes No If no, please explain: 8. Where did the dog live when no one was home? (check all that apply) Free run of the house Crated In fenced yard In garage or basement Confined to kitchen/bathroom Outside on chain or runner Screened in patio Electronic pet containment Other: 9. If the dog is crate trained, how many hours did it spend in the crate each day? 10. Has your dog ever been kenneled at a: (check all that apply) Private boarding facility Veterinarian Animal Shelter If yes, how did your dog react to being boarded? 11. Where does your dog sleep at night? 12. Has your dog lived with or been around children? Yes No If yes, what were the children s ages and how did they interact?

4 MANNERS AND TRAINING 1. Is this dog housetrained? Yes No Almost (started training) If no, please explain: 2. Can the dog be allowed off-leash and come when called? Yes No 3. Can this dog be left alone in the house for 8 hours a day without issues? Yes No If no, why not? 4. Is the dog destructive if left alone inside the home? Yes No If yes, please explain: 5. Please tell us about the desirable tricks and habits you have taught your dog to do: (check all that apply) Basic obedience commands Rides nicely in the car Come when called Play fetch Walk on a loose leash Greets visitors politely Shake/paw trick Takes treats gently Waits for food Get on & off furniture when asked Other: 6. What words does your dog understand? (check all that apply) Sit Stay Down Heel Come Leave it Drop Wait Off Fetch Doesn t know any commands Other: 7. How does the dog react in a car? 8. How does the dog behave on a leash? 9. When the dog is on leash and sees a strange dog or cat, what is its reaction? 10. Is the dog protective or possessive of any of its toys, treats or food? Yes No If yes, please explain: 11. Are there any wonderful or special traits/habits that you would like his/her new family to know about?

5 MEDICAL HISTORY 1. Did the dog see a veterinarian on a regular basis (at least once a year)? Yes No 2. May we contact your veterinarian? Yes No If yes, what is the veterinarian s name and number? 3. Is the dog current on annual vaccinations? Yes No 4. How does this dog react when at the vet? (check all that apply) Calm Nervous Needs to be muzzled Happy/friendly 5. Has this dog ever been hit by a car or required surgery/hospitalization? Yes No If so, please explain: 6. Has this dog ever been diagnosed or treated for any of the following conditions by a veterinarian? (check all that apply) Hair loss Diarrhea Sneezing Coughing Runny eyes Worms in stool Vomiting Other illness/condition: 7. Did a veterinarian diagnose or treat the condition(s)? Yes No 8. Does your dog require any medication on a regular basis? Yes No If yes, explain type of medication and illness: 9. Does the dog allow you to clip his/her nails? Yes No 10. Does the dog liked to be brushed? Yes No 11. Are there places on the dog s body he/she does not like being touched/ brushed/petted? Yes No If yes, please explain: 12. Has your dog ever been professionally groomed? Yes No If yes, how did the dog behave?

6 DIET, EXERCISE, AND PLAY 1. What brand of food do you feed? 2. How often do you feed? 3. Do you feed: Wet food Dry food Combination of wet and dry 4. Does your dog have any allergies or sensitivities to any grains or common food ingredients? Yes No If yes, which grains or ingredients? 5. Describe your dog s play style with other dogs: Please tell us any additional comments about your dog that would be helpful to families considering adopting him/her:

Dog Surrender Agreement and Background Information

Dog Surrender Agreement and Background Information and Background Information Please take the time to fill out this form accurately, honestly, and with as much detail as possible. This information helps us match your dog with a potential adopter. Date:

More information

Canine Surrender Profile

Canine Surrender Profile Canine Surrender Profile Canine Profile The following questionnaire provides Elmbrook Humane Society (EBHS) with more information about your dog in order to learn more about his/her behavior. Because your

More information

Dog Owner Questionnaire

Dog Owner Questionnaire Case # Animal Care & Control 5595 S. Pacific Hwy Phoenix OR 97535 541-774-6654 Fax: 541-774-6607 www.co.jackson.or.us Dog Owner Questionnaire Dogs can t talk, so they can t tell us where or whom they would

More information

Surrendered Dog Information:

Surrendered Dog Information: Surrendered Dog Information: Animal Code # Placer County Resident (Please call before surrendering your pet) It will cost more than $200 to provide care for this animal. As a Placer County resident your

More information

Incoming Dog Profile

Incoming Dog Profile Shelter use only Branch location: Collected by: Dog ID: Incoming Dog Profile The following questionnaire provides us with information about how your dog behaved in many different circumstances while he

More information

Bayside Pet Resort & Spa Dog Personality Profile- Daycare or Group Play

Bayside Pet Resort & Spa Dog Personality Profile- Daycare or Group Play Complete a profile for each dog to be enrolled at Bayside Pet Resort & Spa. Complete responses assist us in the interview process. There are no right or wrong answers as all dogs are unique. Please type

More information

DOG OWNER S QUESTIONNAIRE

DOG OWNER S QUESTIONNAIRE For office use: A# P# DOG OWNER S QUESTIONNAIRE Humane Society Silicon Valley offers pet surrender services as space and resources allow. Our primary role in the community is to save the lives of animals

More information

Has your cat bitten a person or animal or been bitten in the last ten (10) days?

Has your cat bitten a person or animal or been bitten in the last ten (10) days? FELINE QUESTIONNAIRE & PROFILE No one knows and loves your cat the way you do! In order to find the most appropriate home for your cat, please provide as much detail as possible about history, past veterinary

More information

OWNER RELINQUISHMENT FORM

OWNER RELINQUISHMENT FORM 3901 Martha Truman Rd Kansas City, MO 64137 816-761-8151 OWNER RELINQUISHMENT FORM (Please Print Clearly) Pet Owner s First Name: Last Name: Date of Birth: Driver s License #: Address: City: State: _ Zip:

More information

Woofington Guest Profile

Woofington Guest Profile Woofington Guest Profile The Woofington Staff is committed to providing the absolute best experience possible for you and your pet! Please complete the following guest profile (for each pet) so we may

More information

Fort Wayne Obedience Training Club, Inc. Public Class Application

Fort Wayne Obedience Training Club, Inc. Public Class Application Dear Dog Owner: Fort Wayne Obedience Training Club, Inc. Public Class Application Your desire to enroll your dog in our next obedience training class has been brought to my attention. *See application

More information

Canine Behavioral History

Canine Behavioral History Canine Behavioral History Pamela J. Perry, DVM, PhD Animal Behavior Clinic Cornell University College of Veterinary Medicine Ithaca, NY 14853-6401 p. 607-253-3060 f. 607-253-3788 cahadmissions@cornell.edu

More information

LA PLATA COUNTY HUMANE SOCIETY CANINE OWNER SURRENDER FORM

LA PLATA COUNTY HUMANE SOCIETY CANINE OWNER SURRENDER FORM LA PLATA COUNTY HUMANE SOCIETY CANINE OWNER SURRENDER FORM There is a fee for all owner-surrendered animals. Please complete this form along with the attached questionnaire. The information you provide

More information

Incoming Canine Profile

Incoming Canine Profile Dog and Household Information Incoming Canine Profile 1. Dog s Name: 2. Sex: MALE FEMALE 3. Age: 4. Breed: 5. How long have you owned this dog? 6. Spayed or Neutered? YES NO 7. What s your relationship

More information

Dog Surrender Form. History Why are you surrendering this dog?

Dog Surrender Form. History Why are you surrendering this dog? Dog Surrender Form Dog s Name: General Information Gender: Spayed/ Neutered: Age: Breed: Colour: What kind of ID does the dog have? Tattoo: Microchip: History Why are you surrendering this dog? If we could

More information

Cat Owner Questionnaire

Cat Owner Questionnaire Cat Owner Questionnaire 1067 NE Columbia Blvd Portland, Oregon 97211 503-285-7722 Fax 503-285-0838 www.oregonhumane.org No one knows and loves your cat the way you do! In order to find the most appropriate

More information

NORCAL Golden Retriever Rescue Surrender Application

NORCAL Golden Retriever Rescue Surrender Application NORCAL Golden Retriever Rescue Surrender Application In order to find the best home for your Golden, NGRR asks you to complete this rather lengthy application which takes about 20 minutes. We apologize

More information

German Shepherd Resource and Rescue Center. Placement Assistance Application

German Shepherd Resource and Rescue Center. Placement Assistance Application German Shepherd Resource and Rescue Center Placement Assistance Application Please te: Your name, E-Mail Address and State are required to receive a reply from us. All questions must be answered for your

More information

BARK-N-BUDDIES DOGGIE DAYCARE, LLC. Owners Name Date. Address: City: State: Zip: Home Phone Work Phone Work Phone. Cell Cell .

BARK-N-BUDDIES DOGGIE DAYCARE, LLC. Owners Name Date. Address: City: State: Zip: Home Phone Work Phone Work Phone. Cell Cell  . Owners Name Date Address: City: State: Zip: Home Phone Work Phone Work Phone Cell Cell E-mail E-mail Emergency Contact Phone Emergency Contact Phone Veternarian Clinic Address Phone Pet s information:

More information

INCOMING DOG HISTORY SHEET

INCOMING DOG HISTORY SHEET For Staff Use Animal s Name: Age: Sex: Breed/Type: Colour: ID Tattoo Location Microchip # INCOMING DOG HISTORY SHEET Please check all that apply My dog s name is: My dog s gender is: Male Female In heat

More information

Customer Information Sheet

Customer Information Sheet How did you hear about Happy Dogs? Customer Information Sheet Your Name: Address: City State: Zip Home Phone: Work Phone: Cell: Email Address: If we can't get in touch with you who can we call? Contact:

More information

PRE-ADOPTION INFORMATION FORM

PRE-ADOPTION INFORMATION FORM 23 BRANDT LANE PO BOX 24 BLOOMINGDALE, NJ 07403 973-838-2220 PRE-ADOPTION INFORMATION FORM Animal ID#: Animal Name: Welcome to the Bloomingdale Regional Animal Shelter. The following information is requested

More information

Adopt A Boxer Rescue

Adopt A Boxer Rescue Adopt A Boxer Rescue www.adoptaboxerrescue.com Adopt A Boxer Rescue PO BOX 270551 West Hartford, CT 06127 877 570 0360 email: Surrender@adoptaboxerrescue.com. DOG INTAKE QUESTIONAIRE Note: To complete

More information

DOG ADOPTION APPLICATION

DOG ADOPTION APPLICATION DOG ADOPTION APPLICATION Name of Dog(s) you are applying for: Today s Date: Adoption Application Agreement PLEASE READ The speed at which your application is processed for adoption is dependent largely

More information

Behavior History- Canine

Behavior History- Canine Please Print this form, fill it out, and bring it to your appointment. Shaker Veterinary Hospital, P.C. 223 Maxwell Road Latham, New York 12110 Tel: (518) 458-9669 Fax: (518) 453-6107 www.shakervet.com

More information

Feline Facilitated Adoption Profile

Feline Facilitated Adoption Profile Office Use Only Animal #: Program Entrance Date: Staff: Feline Facilitated Adoption Profile Owner s Name: Date: Cat s name: Microchip #: Reason for Surrender: 1. Age 2. How long have you had this cat?

More information

New Client Questionnaire For multiple dog owners please complete one questionnaire for each dog.

New Client Questionnaire For multiple dog owners please complete one questionnaire for each dog. The Crate Escape, Too 5 Green Mountain Drive S. Burlington, VT 05403 865-DOGS (3647) The Crate Escape, Inc. 1108 West Main St Richmond, VT 05477 434-6411 www.crateescapevt.com New Client Questionnaire

More information

Adoption Application Form Registered Charity Number CHY 16481

Adoption Application Form Registered Charity Number CHY 16481 Adoption Application Form Registered Charity Number CHY 16481 Please fill-out the details below and hit submit. We will be in touch shortly. The details that you provide will help us to match you with

More information

DOG SURRENDER PROFILE COCHECO VALLEY HUMANE SOCIETY

DOG SURRENDER PROFILE COCHECO VALLEY HUMANE SOCIETY DOG SURRENDER PROFILE COCHECO VALLEY HUMANE SOCIETY No one knows and loves your dog the way you do! In order to find the most appropriate home for your dog, please provide as much detail as possible about

More information

Saving Grace and Her Furry Friends 501(c) 3 Non-Profit Organization

Saving Grace and Her Furry Friends 501(c) 3 Non-Profit Organization Saving Grace and Her Furry Friends 501(c) 3 Non-Profit Organization Scan and email to: Stefanie 954-562-8813 savinggracefl@gmail.com Fax: 954-382-0100 (call to make sure someone is home before faxing)

More information

Adopter Information Form Canine Pet Rescue Corp Jones Phillips Road Dacula, GA 30019

Adopter Information Form Canine Pet Rescue Corp Jones Phillips Road Dacula, GA 30019 Adopter Information Form Canine Pet Rescue Corp. 2625 Jones Phillips Road Dacula, GA 30019 Thank you.. for your interest in sharing your life with a dog. We believe that every dog deserves a safe, loving

More information

Pflugerville Pets Alive!

Pflugerville Pets Alive! FACTORS FOR ADOPTERS TO CONSIDER BEFORE ADOPTION Pflugerville Pets Alive! wants nothing more than to match one of our pets to a new adopter. Over time, we have discovered that there are many things that

More information

PAROLED PET ADOPTION APPLICATION

PAROLED PET ADOPTION APPLICATION PRISON PET PARTNERSHIP 9601 Bujacich Rd. Gig Harbor, WA 98332 T: (253) 858-4240 F: (253) 858-4202 info@prisonpetpartnership.org PAROLED PET ADOPTION APPLICATION ***Adoption fee for dogs varies. Adoption

More information

THE ARK FOSTERCARE PROGRAM

THE ARK FOSTERCARE PROGRAM THE ARK FOSTERCARE PROGRAM In order to assist you in finding your new family member, we ask that you read and complete the attached application. ADOPTION REQUIREMENTS: Completed application Waiting period

More information

Doggie Day Care Agreement and Profile

Doggie Day Care Agreement and Profile Doggie Day Care Agreement and Profile The Dog House 12704 Foust Road Conneaut Lake, PA 16316 (814)382-2267 Date In: Time In: By (Staff): Date Out: Time Out: By (Staff): Owner Name: Address: City: State:

More information

NORTH MECKLENBURG ANIMAL RESCUE ADOPTION APPLICATION

NORTH MECKLENBURG ANIMAL RESCUE ADOPTION APPLICATION NORTH MECKLENBURG ANIMAL RESCUE ADOPTION APPLICATION Date: Type/Name of dog desired? Age of dog desired? Approximate weight as an adult? APPLICANT INFORMATION Name: Age: Address, City, State, Zip: How

More information

Dog Boarding Information and Agreement Please use BLACK INK only.

Dog Boarding Information and Agreement Please use BLACK INK only. Dog Boarding Information and Agreement Please use BLACK INK only. Please answer all questions in an honest manner. We all want the best place for your dog s vacation. If your dog becomes destructive, aggressive,

More information

Canine Relinquish Form

Canine Relinquish Form Canine Relinquish Form I of Full Name (Please Print) Address (Please Print) do hereby relinquish the Animal(s) described below. City/Town/Postal Code (Please Print) Identification: Phone: E-Mail I hereby

More information

Lily s Legacy Senior Dog Sanctuary Adoption/Foster Application

Lily s Legacy Senior Dog Sanctuary Adoption/Foster Application About You and Your Family Your name: Spouse's name: Address: City/State/Zip: HomePhone: Work Phone: Cell Phone: E-mail Address: Your occupation: Spouse's occupation Please describe any animals you currently

More information

Name of Animal Type of Animal Cat Dog. Applicant's Name. Address: Home Phone ( ) Work Phone ( ) Driver's License # Date of Birth.

Name of Animal Type of Animal Cat Dog. Applicant's Name. Address: Home Phone ( ) Work Phone ( ) Driver's License # Date of Birth. Page 1 of 6 Date Name of Animal Type of Animal Cat Dog Applicant's Name Address: City State Zip code Home Phone ( ) Work Phone ( ) Driver's License # Date of Birth Email Address Welcome to the Humane Society

More information

Thank you for choosing Camp Wagging Tails. Please complete the following forms for your camper(s):

Thank you for choosing Camp Wagging Tails. Please complete the following forms for your camper(s): Dear Dog Owner: Thank you for choosing Camp Wagging Tails. Please complete the following forms for your camper(s): Statement of Authorization Owner Agreement Emergency Contact Form Pet Personality Profile

More information

Behavior Monitoring Questionnaire

Behavior Monitoring Questionnaire Behavior Monitoring Questionnaire Please complete the following information and submit 24hrs before scheduled appointment. Behavior problems can be frustrating and difficult to correct. The information

More information

The Dog Spot Guardian Profile

The Dog Spot Guardian Profile Guardian Profile Today s Date: Guardian Name: Dog s Name: Address: City: Zip Code: Home Phone Number: Business Phone Number Cell Phone Number: Email Address: Emergency Contact (Person not traveling with

More information

Dog Day Care and Pet Boarding Guest Profile

Dog Day Care and Pet Boarding Guest Profile N29W23950 Schuett Dr. Pewaukee WI 53072 Phone: (262) 347-0787 Fax: (262)347-0780 www.pewaukeeveterinaryservice.com Owner/Pet Parent Name: Dog Day Care and Pet Boarding Guest Profile Client Information

More information

HERKIMER COUNTY HUMANE SOCIETY P.O. BOX 73, MOHAWK, NEW YORK PHONE: (315) ; FAX: (315)

HERKIMER COUNTY HUMANE SOCIETY P.O. BOX 73, MOHAWK, NEW YORK PHONE: (315) ; FAX: (315) DATE: NAME OF ANIMAL: DOG CAT PUPPY KITTEN Title Page HERKIMER COUNTY HUMANE SOCIETY P.O. BOX 73, MOHAWK, NEW YORK 13407 ADOPTION POLICIES AND FEES PLEASE READ CAREFULLY BEFORE COMPLETING ADOPTION APPLICATION

More information

Ruuff Luv Doggie Daycare & Hotel

Ruuff Luv Doggie Daycare & Hotel Thank you for considering RuuffLuv Doggie Daycare & Dog Hotel. We are committed to providing a safe, fun, and stimulating social environment for your dog. At doggie daycare, your dog will not be crated

More information

CANINE BEHAVIOR CONSULTATION QUESTIONNAIRE

CANINE BEHAVIOR CONSULTATION QUESTIONNAIRE CANINE BEHAVIOR CONSULTATION QUESTIONNAIRE The information you provide is important in diagnosing and treating your pet's behavior problems. Please fill out this form as completely as possible. If additional

More information

Central PA Humane Society - Dog Adoption Application

Central PA Humane Society - Dog Adoption Application Page 1 Central PA Humane Society 1837 East Pleasant Valley Boulevard Altoona PA 16602 Phone: (814) 942-5402 Fax: (814) 942-8505 www.centralpahumane.org Central PA Humane Society - Dog Adoption Application

More information

Pet Selection Consultation Services

Pet Selection Consultation Services Pet Selection Consultation Services Congratulations! Bringing a new pet into your home is not only exciting and rewarding, but challenging as well. We want to help you make the best possible choice as

More information

CANINE BEHAVIOR HISTORY FORM

CANINE BEHAVIOR HISTORY FORM CANINE BEHAVIOR HISTORY FORM PLEASE READ CAREFULLY: Please complete this form with as much details as possible and return it to us before your appointment. You may email it to behaviorist@livs.org or fax

More information

Behavior Solutions: Children and Dogs

Behavior Solutions: Children and Dogs Behavior Solutions: Children and Dogs Bringing home a new baby is an exciting time for everyone in the house, including your dog. Routines that your dog has been accustomed to are likely to be disrupted,

More information

MILITARY WORKING DOG (MWD) ADOPTION APPLICATION

MILITARY WORKING DOG (MWD) ADOPTION APPLICATION FAX 210-671-3402 Website: http://www.lackland.af.mil/units/341stmwd/ MILITARY WORKING DOG (MWD) ADOPTION APPLICATION Thank you for considering the adoption of a MWD. Please take a few moments to carefully

More information

NOTE: OUR DOGS ARE INSIDE DOGS.

NOTE: OUR DOGS ARE INSIDE DOGS. ADOPTION APPLICATION If you have decided you would like to apply for adoption of one of our rescued Labrador Retrievers, please take time to fill out the following adoption form as completely as possible

More information

FaerieLand Rescue. Foster Home Questionnaire. Information About You and Your Household

FaerieLand Rescue. Foster Home Questionnaire. Information About You and Your Household Foster Home Questionnaire Thank you for your interest in becoming a foster home to one of our rescued German Shepherd or Corgi dogs. Our organization relies heavily on foster families to save dogs lives,

More information

PLAY ALL DAY, LLC R E G I S T R A T I O N F O R M

PLAY ALL DAY, LLC R E G I S T R A T I O N F O R M Today s Date PLAY ALL DAY, LLC R E G I S T R A T I O N F O R M Start Date How did you hear about us? Pet Owner(s) O W N E R I N F O R M A T I O N Home Address City, State, Zip Home Phone ( ) Work Phone

More information

Home Phone with Area Code: Occupation: Work Phone with Area Code: Mobile Phone with Area Code:

Home Phone with Area Code: Occupation: Work Phone with Area Code: Mobile Phone with Area Code: Moonracer No Kill Animal Rescue Inc- 941-896-6701 Foster Application Name: Address: (Apt. #): City: State: Zip: Home Phone with Area Code: Occupation: Work Phone with Area Code: Mobile Phone with Area

More information

Emergency Contact Information

Emergency Contact Information Emergency Contact Information Owner Information Name: Address: City: Home phone: Work Phone: Email: Is it ok to send pictures/updates to this email? Y-N Cell Phone: Emergency Contact Other than yourself

More information

Preparing For a New Dog

Preparing For a New Dog Preparing For a New Dog Contents Are you ready to get a dog? 3 Choosing a breed 4 Hypoallergenic breeds 4 Should you get a puppy or an adult dog? 5 Where to find your dog 5 Picking up your dog 6 Bringing

More information

BARK-N-BUDDIES DOGGIE DAYCARE, LLC APPLICATION. Owner(s) Name Date. Address. City State: Zip. Home Phone Work Phone Work Phone

BARK-N-BUDDIES DOGGIE DAYCARE, LLC APPLICATION. Owner(s) Name Date. Address. City State: Zip. Home Phone Work Phone Work Phone APPLICATION Owner(s) Name Date Address City State: Zip Home Phone Work Phone Work Phone Cell Phone Cell Phone E-mail E-mail Emergency Contact Phone Emergency Contact Phone Veterinarian Clinic Veterinarian

More information

Shiba Inu Rescue of Florida Application to Adopt

Shiba Inu Rescue of Florida Application to Adopt Shiba Inu Rescue of Florida Application to Adopt This application was designed to help SIRF get to know you and to determine if our foster dog is a match for your family. If some of the questions seem

More information

Taysia Blue Siberian Husky Rescue Adoption Application

Taysia Blue Siberian Husky Rescue Adoption Application PERSONAL INFORMATION Taysia Blue Siberian Husky Rescue Adoption Application 1. IMPORTANT! Save this PDF to your computer s hard drive. 2. Open the saved file in Adobe Reader. 3. Fill it out. 4. Save the

More information

OWNER SURRENDER FORM

OWNER SURRENDER FORM P.O. Box 110987 Naples Florida 34108 Phone/Fax: 239-369-0415 info@grrswf.org www.grrswf.org OWNER SURRENDER FORM We understand that giving up your pet may be a difficult decision, but we realize that in

More information

Kane County Department of Animal Control. Dog Adoption Application

Kane County Department of Animal Control. Dog Adoption Application Kane County Department of Animal Control 4060 Keslinger Road Phone: 630-232-3555 Geneva, Illinois 60134 Fax: 630-232-3585 Robert B. Sauceda Administrator Jane Davis, DVM Deputy Administrator Dog Adoption

More information

Dog Days Phone: East Pleasant Valley Boulevard Fax: DOG DAYS POLICIES

Dog Days Phone: East Pleasant Valley Boulevard Fax: DOG DAYS POLICIES Dog Days Phone: 814-932-1226 1525 East Pleasant Valley Boulevard Fax: 814-346-7506 Altoona PA 16602 www.dogdaysofgreenwood.com DOG DAYS POLICIES Dog Days provides high-quality, affordable daycare M-F and

More information

DOG PROFILE. Guardian Name(s): #1 (Primary contact): #2: City: Province: Postal Code: Cell Phone: Cell Phone:

DOG PROFILE. Guardian Name(s): #1 (Primary contact): #2: City: Province: Postal Code: Cell Phone: Cell Phone: DOG PROFILE Please complete the following questions to the best of your knowledge. This form and the subsequent assessment are required before your dog can stay with us. This information will help us maintain

More information

St. Francis Animal Shelter. Cats - St. Francis Animal Shelter Adoption Application

St. Francis Animal Shelter. Cats - St. Francis Animal Shelter Adoption Application Pet of interest name: Date: Email address: St. Francis Animal Shelter 109 Flatiron Drive, Buffalo, WY 82834 Voice: 307-684-1738 FAX: 307-621-7003 Cats - St. Francis Animal Shelter Adoption Application

More information

Shelter name: Jonah s Ark Animal Rescue : hereafter Shelter

Shelter name: Jonah s Ark Animal Rescue : hereafter Shelter Shelter name: Jonah s Ark Animal Rescue : hereafter Shelter I, (name of foster applicant), agree that all statements in this application are made based on personal knowledge and are made for purposes of

More information

BAHS Canine Foster Manual. Until they all have a home

BAHS Canine Foster Manual. Until they all have a home BAHS Canine Foster Manual Until they all have a home Table of Contents Welcome Letter...3 BAHS Information.4 Reasons to foster..5 Preparation & Homecoming....5 7 Daily Care 8 Frequently Asked Questions.9

More information

DOGTOPIA DOG ENROLLMENT FORM

DOGTOPIA DOG ENROLLMENT FORM DOGTOPIA DOG ENROLLMENT FORM We are thrilled your dog will be joining the fun here at Dogtopia! Please fill out the forms below, save and email to your preferred location. You can find each Dogtopia location's

More information

NORTHERN ILLINOIS SAMOYED ASSISTANCE, INC P.O. Box 218 Arlington Heights, IL Tel:

NORTHERN ILLINOIS SAMOYED ASSISTANCE, INC P.O. Box 218 Arlington Heights, IL Tel: NORTHERN ILLINOIS SAMOYED ASSISTANCE, INC P.O. Box 218 Arlington Heights, IL 60006 Tel: 847-255-4815 Adoption Request Form NAME: HOME TEL: ADDRESS: WORK TEL: CITY : STATE: ZIP: EMAIL ADDRESS: _ Best time

More information

( ) A dog currently at animal control - This application does not guarantee we are able to pull the dog requested. County: Dog s Name or AC#:

( ) A dog currently at animal control - This application does not guarantee we are able to pull the dog requested. County: Dog s Name or AC#: Foster Application Friends to the Forlorn Pitbull Rescue, Inc. PO Box 2316 Dallas, GA 30132 * Completely fill out the application and return to foster@friendstotheforlorn.org. * All fields are required.

More information

Canine Management - Registration Form

Canine Management - Registration Form Canine Management - Registration Form Human Information Names Primary Phone Cell Text Y / N Email Alternate Facebook Y / N Alternate * Check mark your preferred contact methods above. Street Address Mailing

More information

! Owners Name:!! Address:!! City State Zip!! Cell phone Home phone!! address!! Employer!! Where did you hear about us?!! Name:!

! Owners Name:!! Address:!! City State Zip!! Cell phone Home phone!!  address!! Employer!! Where did you hear about us?!! Name:! APPLICATION FORM Owners Name: Address: City State Zip Cell phone Home phone Email address Employer Where did you hear about us? In Case of Emergency (Contact): Name: Cell Phone Home Phone Pet s name Breed

More information

VOLUNTEER RELEASE (This page MUST be completed by ALL volunteers and foster homes)

VOLUNTEER RELEASE (This page MUST be completed by ALL volunteers and foster homes) VOLUNTEER RELEASE (This page MUST be completed by ALL volunteers and foster homes) I, (print your name), hereby volunteer to represent A.F.E.W. as a Rescue Representative. I attest that the above pages

More information

Austin Sheltie Rescue Adoption Application and Terms of Adoption TERMS OF ADOPTION Care of Our Rescues: Return: Transfer of Ownership: Refund:

Austin Sheltie Rescue Adoption Application and Terms of Adoption TERMS OF ADOPTION Care of Our Rescues: Return: Transfer of Ownership: Refund: Austin Sheltie Rescue Adoption Application and Terms of Adoption Austin Sheltie Rescue PO Box 27872 Austin, TX 78755 512-453-8094 http://www.sheltierescuetx.org Email: swig@sbcglobal.net TERMS OF ADOPTION

More information

Meet & Greet Packet. Name(s): Address: City: Zip: Home Phone: Mobile: Work: Address: How did you hear about us?

Meet & Greet Packet. Name(s): Address: City: Zip: Home Phone: Mobile: Work:  Address: How did you hear about us? Meet & Greet Packet Date completed: Client Information: Name(s): Address: City: Zip: Home Phone: Mobile: Work: Email Address: How did you hear about us? If referred, please tell us who: Emergency Contact:

More information

Luv-N-Bunns Rabbit Rescue & Placement for Abandoned Buns.

Luv-N-Bunns Rabbit Rescue & Placement for Abandoned Buns. Luv-N-Bunns Rabbit Rescue & Placement for Abandoned Buns 8630 Bloomfield Ave Philadelphia, PA 19115 Lizzymcneil@hotmail.com http://www.petfinder.com/shelters/pa570/html www.luvnbunns.org Here are a few

More information

The Pet Lodge of Pinehurst Boarding Contract. What is the best contact number for you?

The Pet Lodge of Pinehurst Boarding Contract. What is the best contact number for you? Boarding Contract Owner Information Last Name First Name Street City State Zip Email @ Phone Home Cell What is the best contact number for you? Guest Information 1. Pet Name Breed Age DOB Color Sex: Male

More information

Welcome! Please feel free to ask any questions. We strive to have an open door to constant communication with parents about their dog.

Welcome! Please feel free to ask any questions. We strive to have an open door to constant communication with parents about their dog. Parent Handbook Our Services: Daycare Overnights/Kennel Free Boarding Professional Grooming/Self Serve Dog Wash Live webcam viewing of your dog at play Nature Walks Always TLC! Welcome! Thank you for your

More information

Adoption Application If you are not willing to take your role as a pet owner serious, please do not apply.

Adoption Application If you are not willing to take your role as a pet owner serious, please do not apply. If you are not willing to take your role as a pet owner serious, please do not apply. I am interested in adopting: Your Full Name Date of Birth (Must be 21 to apply) Name of Spouse/Significant Other Date

More information

Dog and Puppy Foster Manual. Sioux Falls Area Humane Society

Dog and Puppy Foster Manual. Sioux Falls Area Humane Society Dog and Puppy Foster Manual Sioux Falls Area Humane Society Thank you for your interest in the Sioux Falls Area Humane Society s foster program! Fostering can be very rewarding and it helps to save the

More information

Greyhound Pets of America/Lexington, KY. Adoption/Foster Application

Greyhound Pets of America/Lexington, KY. Adoption/Foster Application Greyhound Pets of America/Lexington, KY Adoption/Foster Application Thank you for your interest in adopting or fostering a retired racing Greyhound. Greyhounds make wonderful companion pets and will give

More information

GLEN HIGHLAND FARM, SWEET BORDER COLLIE RESCUE

GLEN HIGHLAND FARM, SWEET BORDER COLLIE RESCUE GLEN HIGHLAND FARM, SWEET BORDER COLLIE RESCUE ADOPTION APPLICATION GLEN HIGHLAND FARM, SWEET BORDER COLLIE RESCUE 217 Pegg Road, Morris, NY 13808 Lillie Goodrich 607-263-5415 fax: 607-263-5325 email:

More information

Housebreaking Your New Dog

Housebreaking Your New Dog Housebreaking Your New Dog Housebreaking a new BRLA Boxer: The good news is that most rescue dogs are 6 months of age or older. As apposed to puppies, who don t even know when they are going to the bathroom,

More information

Applicant: I am interested in the following animal (s): 1: Dog

Applicant: I am interested in the following animal (s): 1: Dog Applicant: I am interested in the following animal (s): 1: 2: 3. Dog HSMC staff strives to process your application as quickly as possible. Please be sure to carefully read the questions and leave nothing

More information

Professional pet sitting and Dog boarding in Colchester, Essex

Professional pet sitting and Dog boarding in Colchester, Essex Professional pet sitting and Dog boarding in Colchester, Essex Booking form: contact details Please answer ALL questions as accurately as possible to ensure the safety of your pet, thank you. YOUR DETAILS

More information

1. Name of client(s): 2a. Today s date: (day) / (mo) / (year) 2b. Dog s date of birth: (day) / (mo) / (year) 3. Patient: 4a.

1. Name of client(s): 2a. Today s date: (day) / (mo) / (year) 2b. Dog s date of birth: (day) / (mo) / (year) 3. Patient: 4a. 1 Survey Questionnaire About General Canine Behaviors* When used at each visit, this questionnaire will help clients and veterinarians assess the potential for behavioral problems in your dog so that help

More information

OWNER INFORMATION Initial date:

OWNER INFORMATION Initial date: PTV OWNER INFORMATION Initial date: Date: Date Client Client Name Pet Pet Prescott, AZ. Client phone (Cell / Home / Work ): 928 Email: Breed: Sex: [ M MN F FS ] Canine Dog / Feline Cat / Lapine Hare /

More information

How long have you had this dog? Why are you giving up this dog? Where did you get this dog from? Veterinarian(s):

How long have you had this dog? Why are you giving up this dog? Where did you get this dog from? Veterinarian(s): Incoming Dog Profile Dog s name: A#: Sex: male female Spayed/Neutered: yes no Date: Age: Breed(s): How long have you had this dog? Why are you giving up this dog? Where did you get this dog from? Veterinarian(s):

More information

What is Canine Cough, what do you do about it, and can my dog get it?

What is Canine Cough, what do you do about it, and can my dog get it? What is Canine Cough, what do you do about it, and can my dog get it? Canine infectious tracheobronchitis (Canine Cough or Kennel Cough) is one of the most common infectious diseases in dogs. Fortunately,

More information

4-H Dog Record Guide

4-H Dog Record Guide 4-H-M-1154-07 4-H Dog Record Guide Check Project Taken: Wiggles and Wags Your Animal s Photo Here! Canine Connection Leading the Pack Year 20 Name Club County Address Age Years in 4-H Date project completed

More information

DOG CARE PROGRAM OVERVIEW & WORKBOOK

DOG CARE PROGRAM OVERVIEW & WORKBOOK DOG CARE PROGRAM OVERVIEW & WORKBOOK MERIT BADGE UNIVERSITY OVERLAND TRAILS COUNCIL TABLE OF CONTENTS PROGRAM OVERVIEW MERIT BADGE REQUIREMENTS (PRE-REQUISITE REQUIREMENTS IN BOLD RED UNDERLINED ITALICS)

More information

MILITARY WORKING DOG (MWD) ADOPTION APPLICATION

MILITARY WORKING DOG (MWD) ADOPTION APPLICATION FAX 210-671-3402 Website: http://www.lackland.af.mil/units/341stmwd/ MILITARY WORKING DOG (MWD) ADOPTION APPLICATION Thank you for considering the adoption of a MWD. Please take a few moments to carefully

More information

ORIENTATION PACKET TIME CLASS DAY

ORIENTATION PACKET TIME CLASS DAY ORIENTATION PACKET BANDILANE CANINE CENTER Joyce Diamond, CPDT 80 Largo Drive, Stamford, CT 06907 phone: 203-975-8151, fax: 203-975-7457 email: info@bandilane.com www.bandilane.com OWNER S NAME HOME PHONE

More information

BUNNY WORLD FOUNDATION ADOPTION AGREEMENT

BUNNY WORLD FOUNDATION ADOPTION AGREEMENT 1 BUNNY WORLD FOUNDATION ADOPTION AGREEMENT 1) I, me and my hereinafter refers to (name of person adopting a bunny). 2) I agree that Lucky Bunny(s) is/are being adopted as a family pet, and will be given

More information

Long Island Golden Retriever Rescue, Inc. Adoption Application

Long Island Golden Retriever Rescue, Inc. Adoption Application Age Donation under 6 months or dogs from Turkey $600.00 6 months to 6 years $400.00 6 years and over $350.00 Name: Co-Applicant: Address: Date: Home Phone: Work Phone: Cell Phone: Email: 1. Why do you

More information

Puppy Screening Questionnaire

Puppy Screening Questionnaire City: Puppy Screening Questionnaire State: Zip: Home Phone: Cell Phone: Work Phone: Email Website URL: REFERENCES Please note the contacts listed below will be contacted for references. Veterinary Information

More information

Today's Date: Show Location: Applying to: Foster Adopt. Name of Dog(s) Applying for: Breed/Type: Applicant(s) Name: Address: City: State: Zip:

Today's Date: Show Location: Applying to: Foster Adopt. Name of Dog(s) Applying for: Breed/Type: Applicant(s) Name: Address: City: State: Zip: Dog Adoption Application Partnership for Animal Welfare, Inc. * www.paw-rescue.org P.O. Box 1074, Greenbelt, MD 20768 * Tel: 301-572-4PAW * Fax: 888-762-7654 Procedure: * Completely fill out & sign application.

More information

Socialisation and Habituation of Your Puppy

Socialisation and Habituation of Your Puppy Socialisation and Habituation of Your Puppy Please feel free to ask any of our staff at Championvet.com for further information or advice Introduction: What are Socialisation and Habituation? These are

More information

New Client-New Pet Questionnaire

New Client-New Pet Questionnaire New Client-New Pet Questionnaire Date: Your Name: Address: City, State: Zip: Phone: (H) (W) (C) Email address: Emergency Contact Name & Phone Number: Pet s Name: Breed: DOB Color: Sex: Neutered Male Intact

More information