Contact Info
First Name *
Last Name *
Street Address *
City/ Town *
State *
Zip Code *
Primary Phone *
Secondary Phone
Email *
About your dog
Dog's name *
What is the dog's primary breed? *
What is the dog's date of birth? *
What is the dogs age? Specify years, months, and weeks. *
Dog's sex *
Female Male
Is the dog spayed/ nuetered? *
Yes No
Dog's weight? *
When did you get the dog *
How long have you owned the dog? Specify years, months, and weeks. *
Where did you get the dog? *
Breeder
Facebook
Friend/Family
Craigslist
Rescue Organization
Shelter
Other
If you answered rescue, shelter, or other please specify where the dog came from. *
Please include a photo of the dog *
Health Information
Has the dog been seen by a veterinarian? *
Yes
No
I take the dog to clinics
Name of the vet/ clinic that the dog been to. *
Veterinarian's phone *
What current vaccinations does the dog have? *
Select all that apply
None
Rabies
Bordatella
Distemper/Parvo
Lyme
Lepto
Whose name are the vet records under? *
I understand that i need to email a copy of my dogs medical records to adoption@helpinghoundsny.com *
Yes
By submitting this form you understand Helping Hounds Dog Rescue will be contacting your vet. You authorize that your vet can share all records about your dog and your dog's medical history with Helping Hounds Dog Rescue.
Behavioral Information
How many adults are in the home? *
Are there any children in the home? (Select all that apply) *
No
Yes, under 5 years old
Yes, 5 - 12 years old
Yes, over 12 years old
Are there other pets in the home? *
Yes
No
Please list other pets in the home *
Is your doog good with... (Select all that apply) *
Other Dogs
Cats
Children
Dog Parks
Doggy Daycare
On a daily basis what is the dogs energy like? *
High- Very active, best for hiking, walks and many adventures
Medium-Active but settles well-best for walks, weekend trips to parks, can sustain a longer time away from humans.
Low-mostly calm, snuggle buddy but enjoys short walks.
Does the dog display any type of seperation issues, when left alone? *
Yes
No
Please explain
Is the dog housetrained? *
Yes
No
Selective (not 100% but working on it)
Is the dog crate trained? *
Yes
No
Selective (not 100% but working on it)
Does the dog go to the bathroom in the crate? *
Yes
No
Selective (not 100% but working on it)
What type of crate is used? *
Wire
Plastic
None
Other
How long is the dog crated? *
0-4 Hours
4-8 Hours
Longer than 8 hours
Do you take the dog for walks on a leash?
Yes
No
Is the dog protective of anything (food, toys, treats, people, furniture, things)? *
Yes
No
What is the dog protective of and what is it that they do? *
Has the dog been exposed to other dogs? *
No
Yes
Surrender Details
Please describe the reason for the dogs surrender. *
Have you tried to surrender your dog to any other shelters/rescues? *
Yes
No
If yes, what organizations have you tried? *
What reason did the organization give as to why they couldn't help your dog? *