Apply to ReHome a Dog

First Name*
Last Name*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite or Unit Number
City*
State*
ZIP*
Country
- Phone*
History
Hidden
Dog Default Status: Submitted
- Are you the legal owner of the dog?*
  - Yes
  - No
- Please Explain*
- Are you the only owner of the dog?*
  - Yes
  - No
- Please Provide Other Owner's Name:*
- Other Owner's Phone #*
When Did You Get The Dog? (approximate if necessary)*
Month
Day
Year
How Long Have You Had This Dog?*
- How Was The Dog Obtained?*
- Please Explain*
- Breeder's Name (if Known)*
- Have They Been Notified?*
  - Yes
  - No
- Why Not?*
- Owner of Dog's Sire (If Known)*
- Why Are You Giving Up The Dog?*
- Please Explain*
- Please Explain The Behavior Issues*
- Please Explain The Health Issues*
- Please Explain Care Needed*
- How Many Homes Has This Dog Had?
Veterinarian Information
Do You Have a Veterinarian?*
- Yes
- No
Name of Clinic*
Name of Vet
Street Address
Suite or Unit Number
City
State
ZIP
Phone*

- Dog's Name*
- Dog's Registered Name (If Purebred)
- Dog's Registration Number (If Known)
- Primary Breed*
- Breed Name*
- Secondary Breed
- Breed Name
- Primary Color*
- Which Color?*
- Secondary Color
- Which Color?*
Gender*
- Male
- Female
Dog's Date of Birth (If Known)*
Month
Day
Year
Weight*
Energy Level*
- Good With Kids?*
- Good With Dogs?*
- Please Explain*
- Good With Cats?*
- Good With Small Animals?*
Good With Livestock?*
Is Dog Trained?*
- Are There Any Special Needs?*
  - Yes
  - No
- What Special Needs?*
  Select All That Apply
Description of the Dog
Featured Image
Accepted file types: jpg, jpeg, png, gif.
750 Wide x 750 High in Pixels
Additional Photos of The Dog
Drop files here or

Accepted file types: jpg, gif, png, jpeg, Max. file size: 1 MB, Max. files: 3.
Upload Photos of the Dog (minimum of 3 - include one head shot, one full body) and 750 Wide x 750 High in Pixels

Dog & People
- Is Dog A One Person Dog?*
- Does Dog Like Men?*
- Please Explain*
- Please Explain*
- Does Dog Like Women?*
- Please Explain*
- Please Explain*
- Does Dog Prefer Men?*
- Please Explain*
- Does Dog Prefer Women?*
- Please Explain*
- Does Dog Jump On People?*
Is Dog Friendly With Strangers?*
Is Dog Good With Other Animals?*
Is Dog Good With Kids?*
Does Dog Like Kids Under 6?*
Does Dog Like Kids 6-10?*
Does Dog Like Kids Over 10?*
Dog's Temperament*
Select All That Apply
How Are Dog's Social Skills?*
Select All That Apply
Training
Does Dog Know Basic Commands?*
Select All That Apply
Is Dog Obedience Trained?*
Is Dog House Trained?*
Is Dog Crate Trained?*
Is Dog Leash Trained?*
How Does Dog React on Walks?*
Select All That Apply
Does Dog Know How To Use A Doggie Door?*
Does Dog Have Occasional Accidents?*
Does Dog Tear/Chew Furniture Or Carpet?*
Can Dog Be Left Uncrated?*
Does Dog Dig?*
Does Dog Know How To Swim?*
Does Dog Jump Fences?*
Does Dog Escape?*
Does Dog Ride Well In The Car?*
Barking
- Does Dog Bark At Noises?*
- Does Dog Bark At Someone At The Door?*
- Does Dog Bark Excessively?*
Fear & Agression
- Does Dog Exhibit Submissive Behavior?*
- Please Describe*
- Please Describe*
- Does Dog Exhibit Aggressive Behavior?*
- Please Describe*
- Please Describe*
- Does Dog Guard Food?*
- Please Describe*
- Please Describe*
- Does Dog Guard Other Resources (Toys, People, etc.)?*
- Please Describe*
- Please Describe*
- Is Dog Shy?*
- Please Describe*
- Please Describe*
- Is Dog Fearful Of Strange Noises/Storms?*
- Please Describe*
- Please Describe*
- Has Dog Ever Bitten Anyone?*
- Please Explain*
- Has Dog Otherwise Attacked Anyone?*
- Please Explain*
- Has Dog Attacked Another Animal (Dog, Cat or Other)?*
- Please Explain*
- Is there anything else you would like to let us know about the dog's disposition?*

Medical: MicroChip Information
- Is Dog MicroChipped*
- Are you prepared to transfer registration to {RescueName} on or prior to the surrender of the dog?*
  - Yes
  - No
- MicroChip Company (If Known)?
- Other Company
- MicroChip Number (If Known)?
- Does Dog Have a Tattoo?
- Please Upload Photo*
  Drop files here or
  
  Accepted file types: jpg, gif, png, jpeg, Max. file size: 5 MB, Max. files: 3.
- Please Describe*
Medical: Medical Conditions
Add Current Medical Conditions (N Number)
Add Past Medical Conditions (N Number)
Medical: Status
- Is Dog Spayed Or Neutered?
  - Yes
  - No
- Date:
  Month
  Day
  Year
- Expected Date
  Month
  Day
  Year
- Please Explain Why Not
Medical: Dental Conditions
Add Current Dental Conditions (N Number)
Add Past Dental Conditions (N Number)
Medical: Known Allergies
- Add Allergies (N Number)
Medical: Medicines
- Add Medications (N Number)

425.381.3792

425.381.3792

History

Veterinarian Information

Eating

Sleeping

Dog & People

Training

Barking

Fear & Agression

Medical: MicroChip Information

Medical: Medical Conditions

Medical: Status

Medical: Dental Conditions

Medical: Known Allergies

Medical: Medicines

Notes

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