Placement Application

Dog Placement Application

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Home Phone*
Home Phone*

Business Phone

Pet's Name*
Pet's Name*

Breed*
Breed*

Colour*
Colour*

Age of pet*
Age of pet*

Weight*
Weight*

Hair Length*
Hair Length*

Shedding*
Shedding*

Gender*
Gender*

Vaccinations up to date*
Vaccinations up to date*

If not, will the owner complete*
If not, will the owner complete*

Neutered/Spayed*
Neutered/Spayed*

If not, will the owner complete ?*
If not, will the owner complete ?*

Medical history/Special needs/Problems*
Medical history/Special needs/Problems*

Pet's Current Veterinary Clinic Name and Number *
Pet's Current Veterinary Clinic Name and Number *

My Dog Is? (Check all that apply)*
My Dog Is? (Check all that apply)*

Energy Level*
Energy Level*

Explain any behavior issues which may need work*
Explain any behavior issues which may need work*

Is your dog house-trained?*
Is your dog house-trained?*

Is your dog crate trained ?*
Is your dog crate trained ?*

If yes, will you send the crate with your pet?*
If yes, will you send the crate with your pet?*

Where does your dog normally sleep? *
Where does your dog normally sleep? *

Where does your dog normally eat*
Where does your dog normally eat*

What are some of your dog's favorite activities?*
What are some of your dog's favorite activities?*

How many hours of the day is your dog left alone?*
How many hours of the day is your dog left alone?*

My dog lives with:*
My dog lives with:*

My dog lives with other dogs*
My dog lives with other dogs*

Reaction to other dogs*
Reaction to other dogs*

Reaction to cats*
Reaction to cats*

Tell us three things you like about your dog*
Tell us three things you like about your dog*

Tell us three things you would change about your dog:*
Tell us three things you would change about your dog:*

I am surrendering my dog because:* *
I am surrendering my dog because:* *

What advice would you give a potential adopting family about your dog?*
What advice would you give a potential adopting family about your dog?*

Placement Urgency:*
Placement Urgency:*

Please enter the word that you see below.

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