en-Intake Form

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Intake Form - English

Instructions for completing this form: Please provide complete and accurate information about your dog.

Foster home information:

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Basic information about the dog:

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What breed or breeds that best describe your dog?

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If you selected "other" for a breed please enter the dog's breed below. Avoid using "mixed."

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History about the dog:

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Dog's foster environment:

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Including yourself, how many people of the following ages live in the house with the dog? Please fill in the boxes.

Age range (years)FemaleMale
0-3
4-9
10-17
18-29
30-59
60+

How long is the dog left alone, without people, each day? Select one that best applies.

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Where does the dog usually sleep overnight? Select the one that best applies:

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Where does the dog spend most of his/her time?

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What is the dog's energy level in the home?

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Is the dog energetic outdoors but have relaxed energy in the home?

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Dog's behavior:

Please be honest in your answers below. We want to find the right home for this dog and that means a family accepting of its behaviors - good and bad:

How does the dog respond to children?

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How does the dog respond to smaller animals such as cats?

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Is the dog sociable with other dogs?

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Does the dog usually uncontrollably chase or attempt to chase any of the following? Please select all that apply

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When left alone, does the dog usually show any of the following behaviors? Check all that apply:

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How does the dog respond to unfamiliar people you invite into the home? Please select all that apply below:

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How does the dog usually react when a stranger approaches or enters the yard or home? Please select one:

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Does the dog have aggressive behavior over any of these items? Please check all that apply.

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Has the dog ever shown any aggressive behaviors toward men, women, children, dog, or animal specis such as cats? Please Explain.

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Training:

Please describe any training the dog has mastered here.

Extent to which the dog is housebroken:

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Does the dog have "accidents" in the house?

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Do you take the dog outside to go to the bathroom?

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Crate training:

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Leash training:

Have you ever walked the dog on a leash?

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If you have walked the dog on a leash, how does he or she do?

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How is the dog in a car?

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Personality:

Be as descriptive as possible. If you say the dog plays, how does it play (fetch, with other dogs, chase its tail). If it is friendly, give examples (it likes to cuddle in your lap, lick your face). Describe unique things about the dog that you think make it adoptable.

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Ideal home for the dog:

Consider the kind of home where the dog will thrive - not necessarily a replication of its foster home.

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Is the dog suitable for a home with children?

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Is the dog suitable for a home with cats or other small animals?

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Is the dog suitable for a home with other dogs?

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Dog food program:

Note: If you are already on the food program and have received food (based on the foster home details you entered above), we will add this dog to your current distribution unless you indicate "No". Food distribution calculations are performed every Sunday. We will update your next pickup date at that time.

There is a weekly posting for the pick up date for food. We will use your email address or your facebook name to invite you to the closed Facebook group so you can see the weekly post.

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Thank you for saving this dog and for taking the time to provide us the most complete and accurate information possible! We want to find a home where this dog will not only be safe, but will thrive! Together we can do it!