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.
Dog's Name
Sex
Age
Weight (Approximate)
Primary/Secondary Breed
Coloring and any distinctive marks
Has your dog ever bitten another animal and/or a person?
Why are you surrendering this dog?
What is your relationship to the dog's owner.
Is this dog part of a bonded pair?
What actions have been taken to find the dog a new home?
How many owners has the dog had?
How long have you or the most recent owner had the dog?
Has the dog been an indoor pet?
Do you have a deadline for when you must physically surrender the dog or are you able to keep (foster) the dog until a suitable home is found.
This is not a requirement for us to take your dog. We ask because it helps our rescue. Are you able to help defray our cost (in full or in part, even a small part) in preparing your dog for adoption, including bringing them up to date on any pending vaccinations, conducting a heartworm test, performing bloodwork, and/or spaying or neutering them if this has not been done yes? This is our standard medical protocol for any dog that is surrendered to us.
To get an idea of the dogs personality, obediance and who it gets along with
Is your dog housebroken?
How long can the dog go between potty breaks, without having an accident?
For how long can your dog be alone without having fear and/or anxiety, or without barking or whining?
Does the dog get along with cats?
Does the dog get along with other dogs?
Does the dog get along with children?
If the dog has or has not gotten along with children, please indicate age ranges.
Does the dog have a preference for certain people?
How would you describe the dog's personality?
How does the dog like to play?
What percent of the time would you say that the dog is obedient:
What do you think would be an ideal home for this dog?
What energy level would you rate the dog?
Does the dog indicate a need to go out?
Is the dog groomed periodically?
Is your dog able to walk on a leash without pulling or barking?
Please list the commands your dog obeys.
What type of food is the dog accustomed to eating? Please be as specific as you can (brand, dry, wet).
What is your dog's feeding schedule?
Are there any eating or food issues?
Has the dog received a heartworm preventative?
Has your dog been diagnosed or treated for medical issues/conditions?
Veterinarian's Name and Contact Information
Has the dog been received flea and/or a tick preventative?
What are your dog's vaccines and dates, if known?
Is the dog spayed or neutered?
Would you be able to have your dog’s medical records emailed to us at karinareyes1014@gmail.com as soon as we accept your dog into our rescue? (All information, including your identification, will be kept confidential and will not be released to the new dog's owners when adopted.)
Does the dog have any I.D. (tattoo, microchip)?
By typing my name below, I certify that I am prepared to willingly relinquish ownership of the above dog to Citizen Canine Senior Dog Rescue, pending their acceptance (based on foster/adopter availability) of my dog, I certify that I am the owner or designated caregiver of this animal, or that the animal is a stray and the owner is unknown to me. I relinquish and give up all rights and claims to this dog.
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.