RESCUE ASSISTANCE REQUEST

Your Name *

Your Best E-Mail *

Your Phone Number *

Dog’s Name *

Breed *

Microchipped? * YesNo

Spayed/Neutered? * YesNo

Why Do You Want to Surrender (or Need Assistance with) Your Dog? *

Do You Adopt Your Dog, Purchase From a Breeder, or Other? * We Adopted This DogWe Purchased From a BreederWe Acquired Privately

If You Adopted, What Organization Did You Adopt From?

If You Adopted, Have You Contact This Organization re: Returning the Dog to Them? YesNo

What Did They Say?

What Kind of Food are You Feeding Your Dog? *

If Your Dog Has Any Known Allergies, Please List Them:

Does Your Dog Have Any Other Medical Issues or Physical Concerns?

Please List All Meds & Supplements Your Dog Takes, and the Reason for Each

Has Your Dog Ever Been Aggressive Towards (Growling, Lunging, Snapping) or Bitten a Person? If So, Explain: *

Has Your Dog Ever Been Aggressive Towards (Growling, Lunging, Snapping) or Bitten Another Dog? If So, Explain: *

Has Your Dog Ever Shown Possessive or Resource Guarding Behaviors Around Food or Toys? Explain: *

Has Your Dog Ever Been Cared For by Another Person Outside of Your Home (Pet Sitter, Boarding Facility, Etc)? *

If So, Did Your Dog Have Any Issues During the Time You Were Away?

Is Your Dog Housebroken? * YesNo

Can Your Dog Remain Calm in a Crate for at Least 4 Hours at a Time? * YesNo

What Commands Does Your Dog Know? *

What Commands Does Your Dog Listen To the First Time Asked? *

Is Your Dog Exercised Outside of Your Home or Yard Daily? * YesNo

What Kind of Activities Do You Do Together, and for How Long? *

What Kind of Collar, Leash, or Training Tools Do You Use on Walks and at Home? *

Does Your Dog Walk Respectfully at Your Side When on Leash? *

If Not, What Triggers Any Negative Behavior?

Can Your Dog Hold a Down & Stay Command (Down/Place/Spot/Bed, etc.) for More Than Ten Minutes? * YesNo

Does Your Dog Wait for Permission Before Going Through Thresholds, Getting on Furniture, or Demanding Attention from You? * YesNo

What is Your Dog’s Favorite Activity? *

What is Your Dog’s Least Favorite Activity? *

What Would Have to Change in Order for You to Feel that You Have the Ability to Keep Your Dog in Your Home? *

1 + 0 = ? Please prove that you are human by solving the equation *