Petstablished | Manage your Animal Welfare Organization (AWO) with our easy-to-use software.

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

* GenderMaleFemale

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Your Organizations Information

If you didn't include it above, this will capture information about where the dog is coming from, contact information and your rescue process.

Organization Name & Type

Organization Rescue Contact

Please give the name and contact information for your organizations Rescue Coordinator or main point of contact.

Your role within the organization

Rescue / Outreach CoordinatorVolunteerAnimal Control Officer Shelter Employee Other

If other please give any additional details below

Surrender & Custody Information

This section will provide us with additional information about the animal and how they came into your organizations custody.

Type of Surrender

Owner surrender (with records) Owner surrender (without records) Court Hold Court Ordered removal of the AnimalStray

Date animal entered your custody

Please attach any records you're willing to share about the animal

Where does the animal spend most of its time while in your organizations custody?

This helps us as the dog goes through its decompression period, if they are placed in our organization

Fostered with a family Private Dog Run / KennelShared Dog Run / Kennel Shared play yard timePrivate play yard time Other

General routine for the dogs (type of food, feeding times, play times and treats)

This helps us as the dog goes through its decompression period, if they are placed in our organization

Does the dog have a known bite or aggression history?

YesNo

Medical Information

This section aims to gather the necessary medical information in regards to the animal.

Spayed or Neutered

SpayedNeuteredIntactFemale with no tattoo or records Can have animal fixed prior to transport.

Does the dog have an up to date rabies vaccine?

If unknown, select no.

YesNo

Has the dog received up to date Bordetella or equivalent?

If unknown, select no.

YesNo

Is the dog microchipped?

YesNoWill be prior to transport

Does the dog have any obvious medical issues, or any that were identified during vetting?

Please Attach supporting any vet records here.

Does the dog have an up to date distemper / parvo vaccine?

If unknown, select no.

YesNo

Heartworm Status

HW Negative HW Positive Doxycycline Started (if HW Positive)Prevention Given

Animal Behavior

This section gives will help us find a foster for the animal.

Has the dog been tested with other dogs or known to be good with dogs?

Yes - tested at shelter with staff / behaviorist Yes - per surrender paperwork Unknow/Not Tested Not good with dogs

If dog tested please describe the results below.

Is the dog good with cats/small animals?

YesNoCannot test / Unknown

Is the dog good with children?

Select all age ranges that apply

Children (under 3)3 - 6 years old6 - 9 years old 10 - 12 years old Teens and upNo children

How does the dog respond to touch? Are there any areas they don't want you to touch?

Does the dog show any signs of reactivity?

Please discuss any reactivity observed, the triggers and the dogs response.

Additional Information for Giant Hearts

Please include any additional information and photos below:

Please Provide Some photos of the dog:

Any additional information that would be helpful to our intake team:

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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AWO Rescue Request Form

Personal Information

Your Organizations Information

Surrender & Custody Information

Medical Information

Animal Behavior

Additional Information for Giant Hearts