Name

Street Address

City

State

Zip

Home Phone

Work Phone

Email Address

Date

Breeder and/or Current Owner?

Breeder and Owner Current Owner Other Rescue Group FBVillage Foster Home

Name of Dog

Age of Dog

Gender of Dog

Female Male

Color of Dog

Weight of Dog

Is Dog Spayed or Neutered?

Yes No

Will Dog Spayed or Neutered before Placement?

N/A Yes No

Temperament of Dog

Friendly and Outgoing Quiet and Reserved Timid and submissive Aloof and Reserved Calm and Intelligent Too Smart for his own Good Other

If Other, Describe Dog’s Temperament

Activity Level of Dog

Always in Motion Active Active in Play only Calm Couch Potato Nearly Motionless

Does Dog like Other Dogs?

Likes all Dogs Only Likes Small Dogs Only Likes Big Dogs Only Likes Female Dogs Only Likes Male Dogs Dislikes All Dogs Not Good with Other Dogs Unpredictable with Other Dogs Not Safe with Other Dogs Very Little Exposure to Other Dogs

Does Dog like Cats?

Likes Cats Loves Cats Chases Cats Not Safe with Cats Unfamiliar with Cats

Does Dog like Kids?

Yes No Prefer Home without Kids

Is Dog Object Aggressive?

Not at All Food Aggressive Toy Aggressive Guards Everything

Is Dog Current in Veterinary Care?

Yes No

If not Current, Please Specify Care Needed

Is Dog Handicapped?

No Yes

If Yes, Please Specify Nature of Handicap

Does Dog Have Medical Issues?

No Yes

If Yes, Please Specify Nature of Medical Issues

Is Dog Registered?

American Kennel Club Canadian Kennel Club Other Registry No Registration

If Other Registry, Please Specify

Is Dog Crate Trained?

Yes No

Is Dog Housebroken?

Yes No Almost

Has Dog had any Formal Training?

No Yes

Can Dog be Shipped?

No Yes

Requested Fee for Dog?

Reason for Placing Dog

Feel Free to Add Additional Information about Dog!

Describe Ideal Home for Dog!