Step 1 of 5 20% Section 1: Your InformationToday's Date(Required) MM slash DD slash YYYY Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Who is in the home for people, including yourself?(Required)Please include genders and ages. Who is in the home for other animals, including your dog?Please include species, genders, breeds and ages. Would you please share how you heard about us? Internet Search (i.e. Google) Social Media (i.e. Facebook) Family/Friend Other This knowledge helps us make sure people know about our services. Please share: Section 2: Tell us about your dogYour dog's name?(Required)Age?(Required)To the best of your knowledge, please indicate years and months. Also, include date of birth if known. Gender?(Required) Female Male Spayed or neutered?(Required) Spayed Neutered Unknown Microchipped?(Required) Yes No Unknown How much does your dog weigh?(Required)How long have you owned your dog?(Required)Including yours, how many homes has this dog had?(Required)Please describe what your dog looks like, including breed or mix, if known:(Required)Please upload a recent picture(s) of your dogAccepted file types: jpg, jpeg, png, gif.Where did you acquire this dog?(Required) Breeder Shelter or Rescue Family or Friend Other Please share the shelter or rescue you adopted from(Required)Did you contact them about your situation?(Required) Yes No Please share how that conversation went? Were they willing to take your dog back?(Required)Please share why you have not reached out?(Required)Please tell us more about how you acquired your dog(Required)Why are you looking to rehome your dog?(Required) Section 3: Your Dog's Medical HistoryHas your dog ever been to the vet?(Required) Yes No Unknown Who is your veterinarian/vet hospital?(Required)Please include contact info. How does your dog do at vet/with vet?(Required)Does your dog need to be muzzled or sedated? Any other considerations? Is your dog current on heartworm prevention?(Required) Yes No Please tell us both the brand of prevention and the date it was last given:(Required)Has this dog ever required other surgery other than spay or neuter?(Required) Yes No Unknown Please elaborate on past surgeries:(Required)Does your dog have any medical challenges?(Required) Yes No Please elaborate on any medical challenges?(Required) Section 4: Your Dog's Personality & TemperamentWe ask a lot of questions in this section to best get a feel for your dog and his needs. Please include as much detail as possible to help us get to know him.Please describe your dog's activity level:(Required) Very Active Moderately Active Couch Potato Does your dog enjoy to be touched/petted?(Required)Are there any areas you cannot touch/pet on your dog?(Required)Can you cut your dog's nails?(Required) Yes No Ive never tried Please describe your dog's affection level:(Required) Very Affectionate Somewhat Affectionate Loner Has your dog ever bitten a person and/or other dog?(Required) Never Person Dog Both Please elaborate:(Required)We ask that you provide as much info as possible so we can best proceed, including the who, what, where, when and why of the situation.How would you describe your dog most of the time? (check all that apply)(Required) Talkative Playful Quiet Demanding Friendly to Family Shy to Family Aloof Lapdog Fearful Friendly to Visitors Shy to Visitiors Independent More Like a Cat Fearless Withdrawn Solitary Can't relax What is your dog's favorite toy?(Required)How does your dog like to play? (check all that apply)(Required) Plays Gently Likes to play rough, can be jumpy and/or mouthy Likes to chase ankles Like to learn tricks for treats/clicker train Not much interest in play How does your dog do in the car?(Required)Is there anything your dog is afraid of?(Required)What type of collar does your dog wear? Do they walk on a different collar?(Required)Please indicate the type of collar - buckle, martingale, choke, prong, e-collar, etc. What type of leash does your dog walk on?(Required)Please indicate type of leash - regular or retractable. Do you use a gentle leader or harness? Where do you generally walk your dog? (check all that apply)(Required) Busier neighborhood/road Quiet neighborhood/road Woods When your dog is on leash, do they bark or 'react' to the following? (check all that apply)(Required)Leash-reactive dogs tend to growl, bark, and/or lunge toward things that make them nervous or fearful. Other dogs People Cars Bicycles Cats Wildlife/critters None of the above Please tell us about your dog on leash:What does their 'reactivity' look like? Can they meet dogs and/or people while on leash? The more detail the better! Are there any other behavior concerns we should know about?(Required)This only helps us better set your dog up for success. Section 5: Lifestyle & HomeUntitledWould you please describe your dog's daily routine?We ask a lot of specific questions in this profile, but it's also helpful to get an overall sense of an average daily routine at a high level. This helps us counsel prospective adopters on how to best help them transition. The more info the better!Where does your dog spend most of their time?(Required) Inside Outside Both When inside, where does your dog spend most of their time?(Required)Do you use a crate for your dog?(Required) Yes, they love it. It's a happy place Yes, but they don't love it No, they hate it. Never tried it Please elaborate on our dog's experience with the crate:(Required)Is your dog allowed on the furniture?(Required)When outside, where does your dog spend most of their time?(Required)How does your dog do when you leave the house?(Required)Are they crated, where are they kept, etc.? How does your dog do during the night?(Required)Where do they sleep, do they sleep through the night, etc.? Have you taken your dog to training or trained them?(Required) We went to training I do my own training Please elaborate on your dog's training:(Required)Please include methods used. Please elaborate on your dog's training:(Required)Please include where you went, methods used, etc. If this dog has lived with another dog/dogs, how did they interact? (check all that apply)(Required) N/A Loved each other Caused this dog stress Caused other dog/dogs stress Ignored each other Played with each other Fought with each other Tolerated each other Please tell us additional information about your dog with other dogs - either in the home or outside:(Required)The more info the better. Does your dog guard toys from other dogs, does your dog need a specific introduction, how does your dog do on leash when seeing other dogs? The more information to set your dog up for success the better! If your dog has lived with a cat/cats, how did they interact? (check all that apply)(Required) N/A Cat rubbed on dog Cat feared dog Ignored each other Cat tormented dog Tolerant of dog Dog chased cat Played with each other Fought with each other Had to keep them separated Please tell us additional information about your dog with cats:(Required)Has your dog regularly been around children?(Required) Yes No Not Sure Please elaborate:(Required) Lived with children Regularly been around them in the home and/or outside the home Occasionally around children All of the above Please indicate childrens' ages: (check all that apply)(Required) 0-2 yrs 2-5 yrs 6-10 yrs 11-18 yrs How did they interact? (check all that apply)(Required) Dog actively avoided children Dog snapped and growled at Child could pet dog Ignored each other Dog & child played Mutual adoration Please tell us anything additional about your dog and children:(Required)Who is your dog comfortable with? (check all that apply)(Required) Only really comfortable with me/the family Women Children Teenagers Seniors Visitors Loves all people! How many hours a day was the dog usually left alone?(Required)Any issues or destruction when left alone?(Required)How would you describe the ideal home for your dog?(Required)Are there any quirks or habits you are not fond of in your dog?(Required)Please tell us something truly great about your dog:(Required)Section 6: Dietary HabitsDoes your dog have special dietary needs?(Required) Yes No Please elaborate on dietary needs:(Required)What is your dog's favorite brand and recipe of food?(Required)Which types of food does your dog eat? (check all that apply)(Required) Dry food Wet Food Raw diet only Special diet only Some 'people food' What type of treats does your dog enjoy?(Required)How often is your dog fed?(Required) Food always available/free fed Once daily/designated mealtime Twice daily/designated mealtimes Does your dog guard food or bones from you or other people?(Required)This could include growling, snarling, and snapping when you go near their food or bones. Guards food bowl Guards bones Guards both Doesn't guard either What does that look like? (check all that apply)(Required) Freeze Shows teeth Growl Snap Bite Please elaborate on guarding behavior with people:(Required)Please set the scene for us. What does the guarding look like? What does the dog do? Does your dog guard food or bones from other dogs?(Required)This could include growling, snarling, and snapping when the other dogs go near their food or bones. Guards food bowl Guards bones Guards both Doesn't guard either N/A What does that look like? (check all that apply)(Required) Freeze Shows teeth Growl Snap Bite Please elaborate on guarding behavior with other dogs:Please set the scene for us. What does the guarding look like? What do the dogs do? Section 7: Bathroom HabitsPlease help us by giving us as much detailed information as possible. We understand that a change in environment can result in accidents, but help us understand your dog's bathroom habits in your home. Is your dog housetrained?(Required) Yes No For the most part Please elaborate on bathroom habits:(Required)Do you have a fenced yard?(Required) Yes Electric fence No fence How high?(Required)Is your dog a fence climber or digger?(Required)How often do you walk your dog?(Required)Is your dog able to be off leash?(Required)Section 8: In ConclusionHow much longer can you keep your dog?(Required)If we cannot place this dog due to considerable aggression/medical/behavioral problems, would you take this dog back?(Required) Yes No Please add any additional notes that may help us find the best home for your dog:Consent I agree.By signing below, I certify that the information provided above is accurate and truthful to the best of my knowledge. Signature(Required)PhoneThis field is for validation purposes and should be left unchanged. Δ