Name of the dog   * :
Description/Breed/Mix * :
Age of the dog     * :
Sex of the dog    * :
Male Female
Where did you get this dog from?
SPCA Family/Friends Breeder Pet Store Found Classified/Newspaper Other

Reason for surrender :

Medical History:

When was your dog's last vist to the Vet? :
Veterinarian’s name :
Veterinarian’s phone no. :
Is your dog :
Yes No
Yes No
Yes No
Certificate vaccination?
Yes No
Allergic to something?           
Yes No

Is your dog
House trained? Cage trained? Paper trained? Leash trained? Has seperation anxiety?

Does this dog

Bark? Bite? Chew ?  Jumps? Digs? Escapes?

Does your dog behave well with people in general?
Yes No
Is you dog good with other dogs?  
Yes No
Does your dog behave with children?
Yes No
Is your dog good with cats?
Yes No
Can he be left alone all day?
Yes No
Additional information to help us find your dog a home :

What are your dog’s best qualities?

What are your dog’s worst habits?

What type of home do you think would be best for your dog?


The more information provided about your pet, the more chance your pet will have to find a home.

Please provide details :