Name
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First Name
Last Name
Email
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Phone
*
(###)
###
####
What is your preferred method of communication?
Which best describes your role?
Name of Shelter/Rescue (if applicable)
How did you hear about us?
Option 1
Option 2
Pet Name (if known)
Breed/coloring/markings
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Pet Weight in lbs (estimate is okay)
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Pet Gender
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Male
Female
Pet Age
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How long have you had this dog?
*
Address of Pet's Current Location (include city/state):
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Please check boxes that describe any personality traits you are aware of. Negative answers do not typically affect our ability to accept a dog. We can usually place more quickly if we have a more thorough idea of what type of home the dog will do best in.
*
Please list any known medical conditions or health concerns. Again, negative answers do not affect our ability to accept a dog. We use this information to plan vet appointments.
*
What is the dog's temperament? Check all that apply.
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If the dog is a mix, what breeds is it mixed with?
What bad habits does this dog have, if any?
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What good habits does this dog have?
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Has the dog ever bitten a person? If yes, describe the circumstances.
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Is this pet spayed or neutered?
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Why do you need to transfer ownership of the animal to rescue?
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If accepted into our program, will you be able to transport the animal to Conway, Arkansas?
*
Anything else you'd like for us to know about the animal? Personality traits, fears, any other issues?
