First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

Alt Email

Dog Name*

How old is the dog?*

What is the dog's breed, color and gender?*

Is the dog current on vaccines?*

When was the last vet visit and for what reason?*

Does your dog live mostly indoors, outdoors, or both?*

Where does the dog sleep?*

Is the dog housebroken?*

Is the dog crate trained?*

Does the dog travel well in a car?*

Has the dog been to obedience training?*

Does the dog know basic commands (please list)?*

What is the dog's energy level?*

How does the dog do with strangers?*

Is the dog an escape artist or destructive?*

Does the dog bark frequently?*

Please describe the dog's behavior (be honest and complete).*

Does the dog get along well with children (if yes, what ages)?*

Does the dog get along with cats?*

Does the dog get along with other dogs?*

How does the dog do off leash?*

What activities does the dog enjoy?*

Why are you surrendering this dog (if it is a found dog, please provide when/where/how)?*

What would you consider an ideal home for this dog?*

I certify that all the information provided in this application is true and accurate. Enter your name and date.*