Sex: Male Bitch. Is the dog: Spayed Neutered Entire. Type of Coat Short Semi Long haired
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- 6 years ago
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1 General Information: Date of home check: DOG ASSESSMENT FORM Home check completed by: Dogs name: Name of the owner: Address: Home telephone: Mobile number: address: Where did you hear about us? Dog Information: Breed: Sex: Male Bitch D.O.B/Age: Is the dog: Spayed Neutered Entire If entire Bitch please provide date of last season: If entire Male has he ever been put to stud: Coat Colour: Type of Coat Short Semi Long haired Dog Adoption Pre Home Check Questionnaire
2 Vaccinated? Are there any vaccination certs? Date Booster due: Date of last received worm/flea treatment: History of the dog: Where did you get the dog? How old was he/she when you got him/her? Is he/she good with children? If, please provide age range Has he/she ever lived with another dog? If, please provide details (i.e. breed/age) Has he/she ever lived with cats? Has he/she ever chased livestock? Is he/she good with other dogs? Has he/she ever shown aggression? Has he/she ever bitten anyone? If yes, please give details of event and outcome? Additional information: How does he/she react to strangers coming into the home? How long has he/she been used to being left? Does the Dog chew when left alone in the home?
3 Is he/she used to travelling? (cars) If yes, how does the dog travel? Crate Restrained Harness Does the dog bark excessively? What is your dog s feeding routine? What is the dog fed? Does the dog have any food allergies If, please provide details Is the dog used to getting a bath? Is the dog used to getting its teeth cleaned? Is the dog used to being kept indoors? Does the dog have a microchip/tattoo? If yes, can you provide the documentation? Is the dog house trained? How does your dog let you know when they need to go out to the loo? Has your dog been to training classes? What commands do they respond to? How is the dog on/off the lead? Does your dog have any problems with food or possession aggression? When someone/another animal goes near their food or toys If yes, can you provide details: How does he/she react to loud noises (ie fireworks/thunder)
4 Medical: Has he/she had any medical problems in the past? If yes, please provide details: Does the dog have any medical problems at the present time? If yes, please provide details: How does the dog react to the vet? May we contact your vet? If yes, please provide contact details of your vet? Is there a pedigree? Why? Please give reason(s) as to why you have to re-home your dog: Is there anything else that we should be made aware of about your dog before rehoming that could give cause for concern in his/her new home? If you have your own transport would you be willing to do any travelling to help us out on the day we rehome your dog? Is he/she registered with another rescue for re-homing?
5 We must be told the truth about your dog(s). If at a later date we find out that information was withheld which leads to a dog s behaviour being totally unexpected in it s new home e.g. aggression, savage attack, then we at Team Ilbrey K9 Partners will not be held accountable. If the new owners decide to prosecute then the information given on this form will be provided where necessary. If there is any more information concerning your dog that you feel we should be made aware of then please inform us at the time of filling in this form. Please detail here: Please sign this form to show that a volunteer authorised by Team Ilbrey K9 Partners has been to see you and you are satisfied with details provided. You will be asked to sign a Transfer of Ownership Form at the time of the handover, after which time, you will not be able to have the dog returned. Dog Owner: Signature: Print name: Date: / / Volunteer: Signature: Print name: Date: / /
Dog Profile. Dog s Information: About your Dog s History: Date: / / Animal ID (Staff Use Only): Dog s Name: Breed: Sex: (Check Box) Male Female
Dog Profile Dog s Information: Animal ID (Staff Use Only): Dog s Name: Breed: Sex: (Check Box) Male Female Spayed or Neutered: (Check Box) Yes No Unknown Age: Date of Birth (If Known): About your Dog s
Cat Profile. Animal ID (Staff Use Only) Cat s Name: Breed: Spayed or Neutered: (Check Box) Yes No Unknown Age: Date of Birth (If Known):
Date: / / Cat Profile Cat s Information: Animal ID (Staff Use Only) Cat s Name: Breed: Sex: (Check Box) Male Female Spayed or Neutered: (Check Box) Yes No Unknown Age: Date of Birth (If Known): Declawed:
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