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Canine Surrender Profile

Please fill out this form as accurately and honestly as possible. This information will help match your dog with his/her new family. The more information you are able to provide, the quicker your dog may be adopted. Please refrain from using vulgar, prejudicial, or offensive language. Your attention to detail and accurate completion of this form are both required and appreciated. Any dishonest or false information can lead to the new owner returning the dog to the shelter. Thank you!

Include City & State. Washington County, MD residents only.
What would need to happen for you to keep the dog in your household?
  • {name}
We may not be able to accommodate all dates, but this will help us assess priority.
Has the dog been vaccinated in the past year?
Please bring all medical records with you to your appointment, whether the dog is up to date on vaccines or not
Sex
Has the dog been spayed or neutered?
It can also be called altered or fixed.
Reason For Surrender
  • {name}
If the reason involves behavior issues, how long have they been going on?
  • {name}
Have there been any changes in the home?
move/new baby/people moving in or out/new pets, etc.?
  • {name}
If behavior is involved, have you contacted a behaviorist?
Where did you obtain the dog?
  • This facility
  • Other Shelter
  • Breeder
  • Pet Store
  • Newspaper Ad
  • Friend
  • Found
  • Rescue Group
  • Other
Please list the ages & sexes of the people that the dog has lived with.
  • {name}
Would you recommend placing the dog in a home with children under 8 years of age?
Why or why not?
  • {name}
If the dog lived with children under 8, how did they interact?
  • Dog actively avoided children
  • Ignored each other
  • Jumpen on/knocked over
  • Dog growled at child
  • Played together
  • Child could [pet the dog
  • Gentle/affectionate
  • Unknown
  • Other
Please tell us what kinds of animals the dog has lived with
  • Fixed male dog
  • Un-fixed male dog
  • Fixed female dog
  • Unfixed female dog
  • Cats
  • Other
  • Has never lived with other animals
What has been the dog's experience with other dogs in your home or outside of your home?
  • Never around other dogs
  • Bullies
  • Growls/snaps
  • Ignores
  • Frightened
  • Shy
  • Friendly/playful
  • Curious
  • Lunges on leash
  • Unknown
  • Other
Would you recommend placing this dog in a home with other dogs?
Why or why not?
  • {name}
How has the dog interacted with cats?
  • Never around cats
  • Chases
  • Ignores
  • Curious
  • Gentle
  • Friendly
  • Has injured/killed
  • Barks/lunges at
  • Frightened of
  • Unknown
  • Other
Would you recommend placing this dog in a home with cats?
Why or why not?
  • {name}
How often does the dog go to the bathroom inside the home?
Does the dog "ask" to be let outside to go to the bathroom?
If so, how?
  • {name}
Is the dog crate/kennel trained?
What does the dog do when crated?
  • {name}
If the dog chews, what do they chew on?
  • Doesn't chew
  • Furniture
  • Fences
  • Doorways/windows
  • Socks/clothing
  • Toys
  • Rawhides/bones
  • Steals items & then chews them
  • Other
What does the dog do when you try to take an item away?
  • {name}
Where is the dog when you're home?
  • Always outside
  • Sometimes outside
  • Crate/kennel
  • Loose in the house
  • In garage
  • Chained outside
  • In basement
  • Confined to a room
  • Other
Where is the dog kept when you're not home?
  • Always outside
  • Sometimes outside
  • Crate/kennel
  • Loose in the house
  • In garage
  • Chained outside
  • In basement
  • Confined to a room
  • Other
How many hours does the dog spend alone?
  • Never left alone
  • 0-4 hours
  • 5-8 hours
  • 8-10 hours
  • More than 10 hours
  • Other
How do you confine the dog in your yard?
  • N/A, I don't have a yard
  • The dog runs free in the yard
  • Partial fence
  • Complete fence
  • Stockade/privacy fence
  • Chained to a dog house
  • Chained to stake
  • Other
Has the dog ever escaped?
  • Does not escape or run away
  • Opens latch on gate
  • Climbs the fence
  • Digs under/chews through fence
  • Jumps over the fence
  • Runs away if off-leash
  • Runs but comes when called
  • Other
Has the dog had any training?
  • No training
  • Group obedience class
  • Private sessions with a trainer
  • I trained at home
  • Other
Does the dog respond to any commands?
  • Sit
  • Stay
  • Paw/shake
  • Down
  • Other
Are there any particular people or things that the dog appears to be afraid of?
  • Doesn't seem to be afraid of things
  • Men
  • Dogs
  • Cars/trucks
  • Strangers
  • Loud noises
  • Children
  • Women
  • Cats
  • Water
  • Thunderstorms
  • Vacuums/brooms
  • People in uniform
  • Other
What situations should be avoided that may cause the dog to growl or react negatively?
  • {name}
Has the dog ever had any of the following behaviors?
  • Bitten
  • Snapped
  • Growled
  • Snarled
  • Other
  • None of the above
Did the behavior involve any of the following?
  • Food
  • Rawhide
  • Toys
  • Strangers
  • Children
  • Adults
  • Other Animals
Please give us more details about the circumstances of the behavior.
  • {name}
Does the dog have any previous/current/recurring medical or behavioral issues?
Please describe in detail
  • {name}
Is the dog currently on any medication?
How does the dog react while at the vet's office?
  • Growls
  • Snaps at vet
  • Cowers/fearful
  • Tries to escape
  • Happy/playful
  • Needs muzzle
  • Passive/doesn't care
  • Tolerates
  • Other
Are there any body parts the dog does not like to have touched?
  • None
  • Feet
  • Back
  • Legs
  • head
  • Tail
  • Mouth
  • Belly
  • Other
How do they respond?
  • Snaps
  • growls
  • Lunges
  • Pees/Poops
  • Struggles/attempts to escape
  • Cowers
  • Other
What brand of food are you currently feeding the dog?
  • {name}
What do you believe the ideal home would be for your dog? Why?
  • {name}
Is there any additional information that will help us find the right home for the dog?
Or that you would like their new owner to know?
  • {name}
Do you certify that everything you have said here is true, to the best of your knowledge?
Documents
If you would like to add a photo, or upload any medical records, please do so here.
Attach file
Drop files here

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