Let Us Help Your Dog

WE WILL ONLY TAKE DOGS BACK THAT WE HAVE ADOPTED OUT. IF YOU HAVE NOT ADOPTED FROM US . PLEASE DO NOT ASK US TO TAKE YOUR DOG.

We understand that giving up your dog is an extremely difficult decision. Laura's Hope Rescue wants you to know that we have your dog's best interest at heart. If your dog meets our requirements,We promise to find the best possible home for your dog by carefully reviewing the information you provide us and matching it to corresponding adopters.

You can help us by filling out this intake form. We know it seems long but the more information that you give us, the better chance we have at finding your dog the perfect home. Please be honest with the answers, as it will greatly assist us in determining the best outcome for your dog. In addition, this information (with the exception of your contact information) will be shared with the new adopted family so they know as much background information as possible. Laura's Hope Rescue also asks that when surrendering your dog you send all of their belongings; this includes current food, bedding, toys ect.. in order to make the transition a smooth one.

Completing this form should take no more than 20-30mins. If you have any questions while doing so, please contact us at Laurashoperescue@gmail.com. Please be aware we will ask for you to provide the veterinary records you have and there may be a surrender fee if your dog needs immediate care in order to be able to come to live at the rescue.

There is a fee of $150.00 to take your dog. We will have to take it to our vet to assure it is healthy and to vaccinate or alter if neccessary. If your dog is spayed/neutered and current with all of it's vaccinations we will accept a donation to care for the dog until we find it a home. For the safety of the residents and volunteers , we cannot take dogs that have ANY aggression issues.

Background Information

Dog's Name: *

Male

Female

*

Dog's Date of Birth or Current Age: *

Dog's age when you acquired him or her: *

Is the dog spayed or neutered? *

Yes

No

Has this dog had any other surgeries? *

Yes

No

If Yes, please describe:

Where did you get this dog? *

Dog's breed: *

Is the dog purebred? *

Yes

No

Dog's color and markings: *

Dog's approximate weight: *

Is the dog Microchipped? *

Yes

No

Not Sure

IF yes, please list Registration Number of Microchip:

Why are you surrendering the dog? (Be as detailed/honest as possible) *

Current Household History

Average hours per day this dog spends INDOORS: *

Average hours per day this dog spends OUTDOORS: *

Environment when outdoors? *

Average hours dog is left alone daily: *

Dog's location when left alone: *

Outdoors

Free in house

Confined to a room

Crated

Does dog get upset or anxious when left alone? *

Yes

No

IF yes, briefly describe:

Is dog allowed on furniture? *

Yes

No

Where does the dog sleep at night? *

Is the dog Crate Trained? *

Yes

No

If yes, how often are they in their crate? *

How many hours per day? (or fill in never been crate trained) *

Dog's behavior in their crate: *

Any difficulty going up or down steps? *

Yes

No

If yes, briefly describe:

How often does the dog travel by car? *

Often

Sometimes

Rarely

Behavior while in car? *

Loves

Indifferent

Hates/gets car sick

House Training History

Is the dog housebroken? *

Yes

No

Sometimes

How many times per day does the dog go out to potty? *

Do they alert you somehow? *

If yes, please describe:

Does the dog have 'accidents' in the house? *

Yes

No

If yes, how often? *

Daily	Few times/week	Few times/month
Never has accidents

If yes, what kind? *

Urinates	Defecates	Both
No accidents in house

How long can the dog 'hold it?' *

Not at all

1-3hrs

4-8hrs

8-12hrs

Interaction With People and Other Animals

Please list the ages of all household members the dog currently lives with:

Ages of MEN in household: *

Ages of WOMEN in household: *

Ages of CHILDREN in household: *

Please rate the dog's typical reaction to the following: (Check all that apply)

Men in Household

Friendly	Afraid	Growls	Bites	No Reaction	Avoids
No Men

*

Women In Household

Friendly	Afraid	Growls	Bites	No reaction	Avoids
No Women

*

Children in Household

Friendly	Afraid	Growls	Bites	No Reaction	Avoids
No Children

*

Reactions to Strangers/New People *

During Vet Appointments: *

Reactions to other dogs: *

Please list any further info on interactions with other dogs you may feel is important:

Reactions to cats: *

Please list any further info on interactions with other cats you may feel is important:

How often is the dog in contact with children? *

Daily contact

Weekends only

No Contact

How do children usually treat the dog? *

Kindly/respectfully	Tease or handle roughly	Ignore
No experience with children

What other animals has the dog lived with?

Large dogs *

Male

Female

Both

None

Small dogs *

Male

Female

Both

None

Cats *

Male

Female

Both

None

Other animals? If so, please list types below: *

Male

Female

Both

None

Please list any further info on animals this dog has lived with:

Has the dog ever been in a fight with another dog, animal, or human? *

Yes

No

If yes, please describe:

Training Information

Has the dog ever had obedience training? *

None

Trained ourselves at home

Used a trainer for group or individual classes

What are your general training methods? (Treats, praise, etc...) *

How do you correct or discipline the dog for inappropriate behaviors? *

Responsiveness to training: *

Excellent

Good

Fair

Poor

Any known commands? *

Any other commands?

How would you describe the dog's energy level? *

High

Medium

Low

Behavior

Does your dog do any of the following? Please check all that apply: *

Anything further to add regarding behavior?

Have you consulted with a trainer to fix negative behaviors? *

Yes

No

Behavior around Food and Toys

How does the dog react when someone gets near their food bowl? *

No Reaction

Bites

Shows teeth/growls

Lunges

Are you able to touch the dog or the food bowl while the dog is eating? *

Yes

No

What happens when you touch a toy that's in the dog's mouth? *

No Reaction	Shows teeth/Growls
Bites	Lunges

How does the dog react to being moved while it is sleeping? *

No Reaction

Shows teeth/Growls

Bites

Lunges

Reaction to being pushed or pulled off of furniture? *

No reaction

Shows teeth/Growls

Bites

Lunges

Personality/Temperament

Describe the dog's general disposition and personality: *

Overall, what are the dog's good points? *

Overall, what are the dog's bad points? *

What does the dog like? *

What does the dog dislike? *

What are the dog's favorite toys? *

Fears

Fear of thunderstorms? *

Yes

No

Behavior exhibited:

Fear of fireworks? *

Yes

No

Behavior exhibited:

Fear of vacuum cleaner? *

Yes

No

Behavior exhibited:

Fear of new places? *

Yes

No

Behavior exhibited:

Any other fears? If yes, please describe: *

Feeding/Grooming Informaton

Dog food brand: *

Amount given: *

Times given: *

Given any table scraps? *

Yes

No

Typical appetite: *

Excellent

Good

Poor

Groomed by: *

Owner

Groomer

Not Groomed

Grooming frequency: *

Please check the column that best describes your dog's reaction to the following:

Fur Brushing

Enjoys

Tolerates

Hates

*

Bathing

Enjoys

Tolerates

Hates

*

Nail Clipping (grinder or clipper)

Enjoys

Tolerates

Hates

*

Ear Cleaning

Enjoys

Tolerates

Hates

*

Tooth brushing

Enjoys

Tolerates

Hates

*

Tail Contact

Enjoys

Tolerates

Hates

*

Health Information: Medical records must accompany dog.

Past or present medical conditions:

Ear Infections

Yes

No

*

Itchy skin/hot spots

Yes

No

*

Allergies

Yes

No

*

Arthritis/Hip dysplasia/Stiffness

Yes

No

*

Seizures

Yes

No

*

Gastrointestinal Issues

Yes

No

*

Heart Disease

Yes

No

*

Cancer

Yes

No

*

Any other conditions, or futher information to list regarding above items: *

Is the dog on any current meds?

Yes

No

*

Please list medications here: *

Is the dog currently on a heartworm preventive?

Yes

No

*

What brand and when was last dose given? *

Do you use a topical flea flea/tick preventive?

Yes

No

*

What brand and when was last dose given? *

Does the dog see a veterinarian on a regular basis?

Yes

No

*

Veterinarian Name: *

Veterinarian Address: *

Veterinarian Phone Number: *

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Owner's Name: *

Owner's Street Address: *

Owner's State: *

Owner's City: *

Owner's Zip Code: *

Owner's Email: *

Owner's Home Phone Number: *

Owner's Cell Number: *

Breeder	Friend/Neighbor	Stray
Pet Store	Shelter/Rescue

Free roam/Fenced yard	Kenneled	Tied/Chained
Leash walked	Electronic/Invisible Fence

Daily	Overnight	Occasionally	Rarely
Never been crate trained

Loves	Tolerates	Barks/Whines	Highly Stressed
Never been crate trained

Sit	Down	Come	Stay
Fetch	Give	Shake	None

Jumping on People	Mouthing (grabbing clothes, arms, legs with mouth)	Inappropriate chewing	Stealing food from table/counter	Raiding the trash
Running away	Climbing fences	Digging	Excessive barking	Chasing other animals
Urinating when excited/nervous