Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.
Fill out the form below. Please complete all sections of it.
Dog's name, breed, color, age, and sex:
If female, has she had any litters? If yes, please include number of litters and date of last litter.
How long have you had your dog?
Dog's age when you acquired:
Where did you acquire your dog?
Do you have verbal or written agreement with the breeder or previous owner? If yes, please describe the nature of the agreement.
Is the dog purebred?
Is the dog registered? If yes, please list which kennel club(s) it is registered with.
What is the reason for surrendering your dog?
How did you hear about Refuge Rescue?
Name, Phone number, and Address of veterinarian(s) that have treated your dog:
Date of your dog’s last veterinary exam:
May we contact your vet for treatment verification?
Has your dog received regular heartworm prevention? If yes, please include brand and date of last treatment.
Has your dog received regular flea and tick prevention? If yes, please include brand and date of last treatment.
Is your dog spayed or neutered? If yes, include date of surgery.
Does your dog have any medical condition(s) that a new owner should be aware of? If yes, please describe.
Does your dog have any skin conditions, allergies, or hot spots?
Has your dog had any surgeries other than spay/neuter? If yes, please describe and state when the surgery was performed.
Does your dog have a microchip?
Does your dog live primarily inside or outside?
Is your dog housetrained?
How does your dog "ask" to go outside?
What is your dog's energy level?
What does your dog dislike?
What is your dog afraid of?
Is your dog allowed to sleep on furniture?
Does your dog have any habits?
What commands does your dog know?
Has your dog attended training classes? If yes, please list name of trainer/facility.
How does your dog react to other dogs?
How does your dog react to cats?
What are the ages of the children in your household (if any)?
How does your dog react to children?
Can you touch the dog anywhere without negative reaction?
Has your dog ever growled at a person? If yes, please describe the circumstance?
Has your dog ever bitten anyone?
What does your dog like to do?
What type of dog food does your dog eat?
Is the dog possessive of its food bowls?
Can you take food out of your dog’s mouth or touch while eating?
What types of correction methods have been used on your dog?
How would you describe your dog? Please use as many adjectives as possible
Is your dog crate trained?
Do you have a fenced in yard for your dog? If yes, please provide height and type of fence.
Has your dog “escaped” from its enclosure (i.e. fence or crate)? If yes, please describe the circumstance(s).
Please list any additional information that might be helpful to new owners:
Please upload your pet's most recent medical records:
Additional Medical Records: