Apply to ReHome a Dog

First Name*

Last Name*

eMail Address*

eMail Address Confirm eMail Address

Street Address*

Suite or Unit Number

City*

State*

Select State

ZIP*

Country

United States

Phone*

History

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Dog Default Status: Submitted

Are you the legal owner of the dog?*

Yes

Are you the only owner of the dog?*

Yes

Please Provide Other Owner's Name:*

Other Owner's Phone #*

When Did You Get The Dog? (approximate if necessary)*

How Long Have You Had This Dog?*

Select Length of Time

How Was The Dog Obtained?*

Select Method

Breeder's Name (if Known)*

Have They Been Notified?*

Yes

Owner of Dog's Sire (If Known)*

Why Are You Giving Up The Dog?*

How Many Homes Has This Dog Had?

Select Number

Veterinarian Information

Do You Have a Veterinarian?*

Yes

Dog's Name*

Dog's Registered Name (If Purebred)

Primary Breed*

Secondary Breed

Primary Color*

Secondary Color

Gender*

Male

Female

Dog's Date of Birth (If Known)*

Weight*

Energy Level*

Good With Kids?*

Good With Dogs?*

Good With Cats?*

Good With Small Animals?*

Good With Livestock?*

Is Dog Trained?*

Are There Any Special Needs?*

Yes

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?*

Does Dog Like Women?*

Does Dog Prefer Men?*

Does Dog Prefer Women?*

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?*

Does Dog Exhibit Aggressive Behavior?*

Does Dog Guard Food?*

Does Dog Guard Other Resources (Toys, People, etc.)?*

Is Dog Shy?*

Is Dog Fearful Of Strange Noises/Storms?*

Has Dog Ever Bitten Anyone?*

Has Dog Otherwise Attacked Anyone?*

Has Dog Attacked Another Animal (Dog, Cat or Other)?*

Is there anything else you would like to let us know about the dog's disposition?*

Medical: MicroChip Information

Is Dog MicroChipped*

Does Dog Have a Tattoo?

Medical: Medical Conditions

Add Current Medical Conditions (N Number)

Add Past Medical Conditions (N Number)

Medical: Status

Is Dog Spayed Or Neutered?

Yes

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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