INFORMATION ABOUT YOU
Your name
Address
Phone
E-mail
PET INFORMATION
Pet’s name
Pet’s breed
This animal is
Male, neutered Male, not neutered Female, spayed Female, not spayed
Approximate weight
Length of time you’ve owned this animal
PREVIOUS OWNERS
Name
Address
Name
Address
TRAINING
Formal obediance training
yes
no
No response
If yes, where and when?
Walks nicely on a leash?
yes
no
No response
Pulls sometime?
no
yes
No response
Sits on command?
no
yes
No response
Lays down on command?
no
yes
No response
Comes always when called?
no
yes
No response
Won’t come when called?
no
yes
No response
Other training-related comments
SOCIALIZATION WITH DOGS
Never has a problem with other dogs?
no
yes
No response
Sometimes has problems with male dogs?
no
yes
No response
Sometimes has problems with female dogs?
no
yes
No response
Has problems with dominant dogs?
no
yes
No response
Is dominant, himself or herself?
no
yes
No response
Is submissive, himself or herself?
no
yes
No response
Is indifferent?
no
yes
No response
Explain, if necessary
SOCIALIZATION WITH CATS
Has lived with cats
yes
no
No response
Has been around cats and is okay with them?
yes
no
No response
Ignores cats?
yes
no
No response
Chases cats because of interest?
yes
no
No response
Chases cats as prey?
yes
no
No response
Explain, if necessary
Has your dog ever had formal obedience training? Please describe.
Has your dog ever seen a behaviorist? Please describe.
Who will be the primary caregiver?
SOCIALIZATION WITH CHILDREN
Is okay with children?
yes
no
No response
Prefers older children?
yes
no
No response
Has not been around children?
yes
no
No response
BEHAVIOR
Plays with (check all that apply)
Ball
Completely housetrained?
yes
no
No response
Sometimes has accidents?
yes
no
No response
Needs to be housetrained?
yes
no
No response
How does dog tell you he or she wants to go out?
Is okay with a fenced-in yard?
yes
no
No response
Jumps fences?
yes
no
No response
Digs in yard?
yes
no
No response
Does the pet have any fears (i.e., thunderstorms, loud noises, etc.)?
yes
no
No response
Does the pet chew things up?
yes
no
No response
If yes, what?
Can you take things from your pet’s mouth?
yes
no
No response
Can you take toys and food away from your pet?
yes
no
No response
Is there any part of your pet’s body that it doesn’t like touched (i.e., paws, tail, back, etc.)?
Is your pet destructive when left alone?
yes
no
No response
Has your pet ever bitten a human being?
yes
no
No response
If yes, describe the circumstances.
Has your pet ever killed another animal?
yes
no
No response
If yes, describe the circumstances.
VACCINATIONS/MEDICATIONS
Date last heartworm meds given
Heartworm med type
Date last flea treatment
Flea treatment type
Rabies vaccination date
Rabies period
1 year
3 years
DHLPP vaccination dates
First
Second
Booster
Lyme disease vaccination dates
First
Second
Bordetella dates
First
Second
Type
Nasal
Date of last deworming
OTHER INFORMATION
Brand and type of food
Fed
Fed once daily Fed twice daily Free
How much exercise does the dog get daily?
What sort of exercise? (For example, if walks, what distance? If yard time, how much?)
Do you have another dog of other pets in the home? Describe.
Where does the dog sleep?
Names of medications your pet is on and dosages pet must take
Has your dog ever been diagnosed with an ongoing medical condition such as epilepsy or hip dysplasia? If so, what?
Provide any other information you believe would help the foster family for your pet
Why are you giving up this pet?
Are you willing to keep this pet until we can find a home for it?
yes
no
No response
Applicant’s signature
Date
