Shelter Transfer Request

Shelter Name and Address

Name of Contact at Shelter

Preferred Contact Method?

Dogs Name/Identifying Information

Dog Gender

Would the dog be spayed/neutered prior to transferring to our rescue?

Any surgical procedures that the shelter completed or is aware of?

Is the dog purebred? If not, please indicate potential breeds.

Dog's current weight

Dog's approximate age?

Date of birth (if known?)

Dog's color

Reason for initial surrender to shelter? (Please be as specific as possible.)

How long as the dog been in the shelter's possession?

Is the dog considered "at risk" or under any type of deadline such as being euthanized due to behaviors or space? Please provide details if possible.

Do you have any knowledge of the dog's history prior to arriving at the shelter? If so, please provide information:

Are you aware of the dog being registered with any organization? If so, please provide the registry (AKC, UKC, CKC) and registration number

Is the dog microchipped?

If yes, please provide the number and where it is registered

Has the dog seen a veterinarian while with your organization?

Name and contact information for the veterinarian if outside of your shelter

Date the dog was last seen?

Did the dog need to be muzzled or sedated during the examination?

Are you aware of any health problems this dog may have?

If yes, please list all

Does the dog appear to have any skin issues, allergies, or hot spots?

If yes, please provide any known information.

Are you aware of any history with ear infections?

Will the dog be up to date on vaccinations prior to transferring?

Has the dog been tested for Heartworm?

Heartworm preventative brand used?

Last dose date?

Flea/tic preventative brand used?

Last dose date?

Is the dog currently on any medications or a special diet?

If yes, please explain

Current brand of food the dog is being fed?

Can you provide any information around feeding schedule?

Does the dog appear to have a preference for men, women, or does the dog appear to get along with both?

Are you aware of any exposure to children - Toddlers to age 7?

Are you aware of any exposure to children - age 8 and older?

If the dog seems to dislike or fear any type of person, please provide any details you might have.

Has the dog ever growled at, lunged at, or reacted negatively towards a human?

If yes, what details can you provide around the situation(s)?

Has the dog ever made contact with or bitten a person, attempted to bite or snapped at a human, or acted in a way that someone would have thought they were attempting to bite? (This could be shelter or veterinary personnel.)

If yes, please provide any known details around the situation(s)?

Can you easily take food, toys, rawhides, or bones out of the dog's mouth?

Have you witnessed any resource guarding behavior from this dog?

If yes, please explain

Have you ever witnessed any reactivity towards another animal?

If there have been any incidents, please provide any details and indicate if the dane was the instigator of the negative behavior? Did either animal require medical attention?

Has there been any indication of whether or not the dog may be housetrained?

Are you aware of the dog having any formal obedience training?

If yes, please explain

How does the dog behave on leash?

Have you witnessed the dog barking?

Does the barking seem excessive?

Have you observed the dog's behavior when riding in a vehicle?

Is the dog able to have toys/blankets in it's kennel?

If no, please explain.

Select any behaviors you have observed when interacting with the dog?

Does the dog appear to be playful?

What are his/her favorite toys/games/activities?

Is there anything else we should know that will help us find a suitable placement for this dog?