placement-app

Pet Owners Name:
Email Address:
Phone Number: (Home)
Phone Number: (Work/Cell)
Address
City
Postal Code:
About Your Pet - Pet;s Name:
Breed/Mix
Colour/Markings:
Age of Pet:
Approximate Weight:
Hair Length:
My Dog Is:	Male Female
My dog is neutered/spayed:	Yes No
If not, will owner do?	Yes No
Are Vaccinations up to date?	Yes No
If not, will owner do?	Yes No
Date of last rabies vaccination:
Name of dog's veterinary clinic:
My dog is: (Check all that apply)	Friendly Sweet Mean Timid Dominant Aggressive Noisy Destructive Playful Demanding Quiet Other
If other, please explain:
Cute habits my dog has:
Are there behaviour issues that need work?
Does your dog have any kind of ongoing medical problem?
Is your dog house trained?	Yes No In the process
Is your dog crate trained?	Yes No
If yes, will you send the crate with your dog?	Yes No
My dog's obedience level is:	Needs Training Knows basic commands Has been to obedience school
If your dog needs training, please explain:
Where does your dog normally sleep?
I feed my dog:	Dry food only Canned food only Dry and Canned Food My dog eats people food
At what time do you normally feed your dog?
Where does your dog normally eat?
What is your dog's€™s favorite activity?
How many hours of the day is your dog left alone?
My dog lives with:	children under 5 children over 5
My dog is good with:	children under 5 children over 5 not good with children
If not good with children, give reason why:
My dog lives with other dogs:	Yes No
If yes, will your dog share his food bowl with other dogs?	Yes No
Reaction to other dogs:	Good Scared Fights Don't know
My dog lives with cats:	Yes No
Reaction to cats:	Good Chases Kills Don't Know
My dog currently lives in:	House Apartment Other
If you checked other to the above question please specify:
My dog is exercised by:	Running in the yard Walks on leash Leash Free Parks Other
My dog lives:	Mostly Indoor Indoor Only Outdoor Only Equal time spent indoor and outdoor
Is your dog accustomed to:(check all that apply)	Brushing Bathing Nail clipping Groomers
Does your dog have any particular fears such as vacuum cleaner?
Tell us three things you like about your dog:
Tell us three things you would change about your dog:
I would say my dog would be happiest in a home with:	Adults only Family with older children Family any ages Single person Other pets
I am surrendering my dog because:
What advice would you give a potential adopting family about your dog?
Medical history/Special needs/Problems?
Placement Urgency:	Urgent placement needed No urgency but as soon as possible I am willing to wait as long as it takes I can keep my dog until a new home is found
By submitting this application I understand that I am agreeing to proceed with 4 Love of Canines placement process and agree to surrender my pet to 4 Love of Canines with the intention of having it adopted to a permanent suitable new home. I understand that a 4 Love of Canines representative will contact me to arrange placement of my pet but that 4 Love of Canines does reserve the right to refuse any pet it deems unadoptable.	Yes
Date application was sent:
Where did you hear about 4 Love of Canines?
Have you spoken to a 4LC Representative and if so, did you catch their name?