Your Information
First Name
*
Last Name
*
E-mail Address
*
Street Address
*
Street Address (cont'd)
City
*
State
*
Select State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
YT
Zip Code
*
Home Phone
*
Work Phone
Other Phone
The Dog's Information
Name of Dog
Sex of Dog
Male
Female
Date of birth (or estimation of age)
Color
Weight of dog (if estimating,please be as accurate as possible)
Is the dog spayed or neutered?
Yes
No
Temperament info
Please be honest in your answers to the following questions
Is the dog accustomed to and used to children? Please explain
Is the dog accustomed to and used to other animals? Please explain
Please describe the dog's overall temperament
Has the dog ever bitten anyone?
Yes
No
Has the dog ever attempted to bite anyone?
Yes
No
Has the dog ever shown aggression, violent, or inappropriate behavior?
Yes
No
If you answered "Yes" to any of the above questions, please use this space to describe the circumstances:
Veterinary Info
Veterinarian Name
Veterinarian Address
Veterinarian City, State, Zip
Veterinarian Telephone Number
Are the dog's vaccinations current?
Yes
No
Date of last vaccinations, if known
Has the dog been on heartworm preventative?
Yes
No
About The Surrender
Please describe all pertinent details of how the dog came to the attention of the NeoRescue Inc. (for instance, where the dog was found, why the dog is being surrendered/ how the dog was found, etc.)
Please describe the physical condition of the dog. (For instance, general health, coat condition, general fitness, etc.)
Are there any conditions that may need veterinarian treatment. If so, give description (i.e. cherry eye, mange, etc.)
Is this dog adoptable in your opinion? Explain why.
Is there any other information that you can provide that will help rescue find the right home for this dog?
Please type your name here. By doing so, you apply your signature to this form and affirm that all information above is true and correct to the best of your knowledge
Sitemap
| All contents of this site ©2006 NeoRescue Inc. |
Web Access Strategies
|
Contact