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

Country

*State/Province

Dog Information

Please be as truthful as possible. This will help us to find the best foster home possible. We will work with you to determine if we can accept your dog into our rescue program, as well as determine a timeframe.

Name of Setter

Age of Setter

If you know birth date of dog, please share.

Gender

MaleFemale

Has this dog been spayed or neutered?

YesNo

How much does the dog weigh?

Coat/Color Description

Where did you acquire the dog?

How long have you owned the dog?

is the dog housebroken?

YesNoMostly. A few occasional accidents.Unknown

Is the dog crate trained?

YesNo

Is the dog leash trained?

YesNo

Where does the dog currently sleep?

Does this dog get along with other dogs?

YesNoUnsure. The dog has had limited interactions with other dogs.

Has the dog been around cats?

YesNo

If yes, can you describe the interaction with cats?

Has this dog been around children?

Yes. Children of all ages.No. The dog has never been around children.The dog has had some exposure to children, but would prefer to be in a home with adults, only.Other

Do you have a fenced yard?

YesNo

Has the dog ever jumped the fence?

YesNo

Has the dog been trained to an e fence?

YesNo

Has the dog ever bitten anyone?

YesNo

If yes, please explain circumstances.

How does the dog ride in a car?

Please describe interest and reaction. Is the dog hyper and nervous? Or lay down and relax? Is there a history of getting car sick? How often does the dog ride in the car? UNKNOWN is an acceptable answer. Thank you for sharing as much as you can.

Have you taken the dog to public places?

Example: Home Depot, Tractor Supply, Dog Park

Does your dog know or respond to specific commands?

Example: Sit, Stay, Come, Here, Leave it, etc.

What brand of dog food is being used?

Please include how much and how many times per day

Medical Information

Is the dog up to date on vaccinations, including rabies?

YesNo

Has this dog been on monthly heartworm preventative?

YesNo

Has the dog been heartworm tested recently?

YesNo

Has the dog been on flea and tick preventative?

YesNo

Is the dog microchipped?

YesNo

If yes, please enter the microchip number and company if known.

List all medications this dog is currently taking.

Include heartworm, flea & tick preventative, supplements, insulin, etc.

List any known medical issues

List any known behavioral issues or sensitivities we should know about

Example: Doesn't like nails trimmed, doesn't like to ride in the car, separation anxiety, is scared of thunderstorms, etc.

Veterinarian Name and Address

Please include City, State, and Zip Code

Additional Information

Why are you seeking help from rescue for the dog?

Have you contacted other rescue groups or shelters? If so, please list them.

How long are you able to keep your dog before rehoming?

Our foster program relies on volunteers. We do our best to act as quickly as possible, but it can take several days (sometimes longer) to find a foster home. Sometimes, transport will need to be arranged. We need to know how urgent your need is for help and what timeframe we have to work within.

Are you able to help with current vetting needs and/or health certificate to travel?

YesNoUnsure. Let's talk about this, please.

What is the best way to initially contact you?

E-mailPhone callText message

Is there anything else that you wish to share about your dog's health or temperament that you feel is important for us to know?

Please upload a few photos your dog.

Each "question" will allow you to upload one file or photos. You may also email photos to info@oesr.org if you have any trouble uploading directly to this form. Thank you,

Dog photo #2

Dog photo #3

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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Owner Surrender Questionnaire

Personal Information

Dog Information

Medical Information

Additional Information