Dog Information Form

Adams County Humane Society Dog Information Form

This form is designed to help us place find your pet the best home possible with the least amount of stress for him or her. Please be honest in order to help us place your animal with people who understand your animal's needs, behaviors and traits, both good and bad. We want your pet to find a permanent home and not go through the awful experience of being returned to the shelter.

* Indicates required field

Your Name *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Dog's Name and Age *

Male/Female and Breed *

Animal Information

How long have you owned this dog? *

Reason for Surrender *

Where did you get this dog? *

Veterinarian Clinic Used *

Please list any health issues. *

Has this dog had any injuries? *

List any medications this dog takes. *

List any additional information on this dog's health, injuries, special needs or prescriptions. *

Behavior & Habits

Where does this dog spend most of his/her time? *

How would you describe your home? *

Is this dog housebroken? *

Is this dog crate trained? If yes, for how long? *

none *

Can this dog be left alone in the house uncrated? For how long? *

Has this dog been left tied up outside? For how long? *

Kenneled outside? For how long? *

Does he/she like to ride in the car? *

Yes No

Where does this dog usually sleep? *

How does this dog respond to strangers? *

How active is this dog? *

Describe this dog's personality. Is he/she affectionate, calm, excitable, playful, etc. *

What brand of food do you feed this dog? Is it hard or soft food? *

Does this dog get along with other dogs? *

Comment *

Does this dog get along with cats? *

Has this dog been around kids? *

TRAINING:
What type of commands does the dog know: Hand Voice None
What commands does he/she know (circle all that apply): Sit Stay Speak Shake Come Off Down
Other(s):
Does the dog know how to walk on a leash? Y N Does the dog know how to fetch? Y N
Does he/she know other tricks: Y N please explain:

Do you feel there is any other info that would be useful in us helping you place your dog in a new home?

Has this dog been around poultry or livestock? If yes, how did this go? *

Describe how your dog plays. Is he/she aggressive when playing? *

Does this dog like to play in water? *

Yes No

Does this dog have aggression around any of the following: Food Toys People? Please explain. *

Is this dog afraid of anything? If yes, what? *

Has this dog ever bitten anyone? *

Yes No

Submit