Dog Placement Form

About the Owner

Name (required)

Email Address (required)

Phone Number

Address

City
State Zip Code

About the Dog

Dog's Name:

Breed:

Color:

Markings/Resembles what breed?

Hair:
ShortMediumLong

Dog is:
FemaleMale

Spayed or Neutered?
YesNo

If not, will owner do it?
YesNo

Age

Shots current?
YesNo

If not, will owner do it?
YesNo

Rabies Vaccine?
YesNo

Last rabies vaccination date:

If microchipped, please provide microchip mumber:

Weight

Housetrained?
YesNo

Crate trained?
YesNo

Obedience training:
NoneBasicAdvanced

Dog Lives:
Mostly IndoorMostly OutdoorBoth

Where does the dog sleep?

Any behavior problems?

Illness/Medical History:

Name of the dog's Veterinarian/Clinic:

Dog's Personality (check all that apply):
LoverSweetPlayfulTimidProtectiveMeanOther

Other info or cute habits:

Dog currently lives in:
ApartmentHomeMobile HomeOther

Dog has:
No fenced yard, walks on leashPartially Fenced YardAlways TiedFenced Yard - Size?

When loose, dog will:
StayCome when calledRuns but comes backRuns away

Should a fenced yard be required for new home?
YesNo

It cannot be stressed enough that sending us a picture (or pictures) of your dog will increase the chances of adoption considerably.
Please attach up to 3 pictures of the dog (max size 5 mb per picture):

Dog's Behavior with Children

Dog lives with young kids (Under 5)?
YesNo

Dog is good with young kids?
YesNo

Dog lives with older kids?
YesNo

Dog is good with older kids?
YesNo

If not good with kids, why not (be specific)?

Dog's Behavior with Other Dogs

Dog lives with other dogs?
YesNo

Dog's reaction to other dogs (check all that apply)?
UnknownGoodFightsScaredOther

Dog's reaction to non-owned dogs (check all that apply)?
UnknownGoodFightsScaredOther

Dog's Behavior with Cats

Dog lives with cats?
YesNo

Dog's reaction to cats (check all that apply)?
UnknownGoodChasesHurtsKillsOther

Dog's reaction to non-owned cats (check all that apply)?
UnknownGoodChasesHurtsKillsOther

Placement Information

Reason new home is needed:

Urgency:
Can Keep Until PlacedUrgentFoster Home RequestedPossible Euthanization

Owner can keep until:

By submitting this placement form, you agree to continued participation in the adoption process, including providing a picture (whether through this form, or sent later by email or US Mail), attending adoption events when possible, and responding to requests for information in a timely manner.

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