Waiting List Form

Animal information
Name *
Species *	Dog Cat
Gender *	Male Female
Color *	Amber Black Black and Brindle Black and Brown Black and Tan Black and White Black Tortie Blue Blue Tortie Brindle Brindle and Black Brindle and White Brown Brown and Black Brown and White Calico Chocolate Chocolate Tortie Cinnamon Cinnamon Tortoiseshell Cream Diluted Tortie Fawn Fawn Tortoiseshell Ginger Ginger and White Golden Green Grey Grey and White Light Amber Lilac Lilac Tortie Liver Liver and White Orange Ruddy Seal Silver Sorrel Sorrel Tortoiseshell Tabby Tabby and White Tan Tan and Black Tan and White Tortie Tortie and White Tricolour Various White White and Black White and Brindle White and Brown White and Grey White and Liver White and Tabby White and Tan White and Torti Yellow and Grey
Breed *	Affenpinscher Afghan Hound Airedale Terrier Akbash Akita Alaskan Malamute American Bulldog American Eskimo Dog American Staffordshire Terrier American Water Spaniel Anatolian Shepherd Appenzell Mountain Dog Australian Cattle Dog/Blue Heeler Australian Kelpie Australian Shepherd Australian Terrier Basenji Basset Hound Beagle Bearded Collie Beauceron Bedlington Terrier Belgian Shepherd Dog Sheepdog Belgian Shepherd Laekenois Belgian Shepherd Malinois Belgian Shepherd Tervuren Bernese Mountain Dog Bichon Frise Black and Tan Coonhound Black Labrador Retriever Black Mouth Cur Bloodhound Bluetick Coonhound Border Collie Border Terrier Borzoi Boston Terrier Bouvier des Flanders Boxer Boykin Spaniel Briard Brittany Spaniel Brussels Griffon Bullmastiff Bull Terrier Cairn Terrier Canaan Dog Cane Corso Mastiff Carolina Dog Catahoula Leopard Dog Cattle Dog Cavalier King Charles Spaniel Chesapeake Bay Retriever Chihuahua Chinese Crested Dog Chinese Foo Dog Chocolate Labrador Retriever Chow Chow Clumber Spaniel Cockapoo Cocker Spaniel Collie Coonhound Corgi Coton de Tulear Dachshund Dalmatian Dandi Dinmont Terrier Doberman Pinscher Dogo Argentino Dogue de Bordeaux Dutch Shepherd English Bulldog English Cocker Spaniel English Coonhound English Pointer English Setter English Shepherd English Springer Spaniel English Toy Spaniel Entlebucher Eskimo Dog Field Spaniel Fila Brasileiro Finnish Lapphund Finnish Spitz Flat-coated Retriever Foxhound Fox Terrier French Bulldog German Pinscher German Shepherd Dog German Shorthaired Pointer German Wirehaired Pointer Glen of Imaal Terrier Golden Retriever Gordon Setter Great Dane Greater Swiss Mountain Dog Great Pyrenees Greyhound Havanese Hound Hovawart Husky Ibizan Hound Illyrian Sheepdog Irish Setter Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Italian Spinone Jack Russell Terrier Japanese Chin Jindo Kai Dog Karelian Bear Dog Keeshond Kerry Blue Terrier Kishu Komondor Kuvasz Kyi Leo Labrador Retriever Lakeland Terrier Lancashire Heeler Leonberger Lhasa Apso Lowchen Maltese Manchester Terrier Maremma Sheepdog Mastiff McNab Miniature Pinscher Mixed Breed Mountain Cur Mountain Dog Munsterlander Neapolitan Mastiff Newfoundland Dog New Guinea Singing Dog Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norwegian Lundehund Norwich Terrier Nova Scotia Duck-Tolling Retriever Old English Sheepdog Otterhound Papillon Patterdale Terrier (Fell Terrier) Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendeen Pharaoh Hound Pit Bull Terrier Plott Hound Pointer Polish Lowland Sheepdog Pomeranian Poodle Portugese Podengo Portuguese Water Dog Presa Canario Pug Puli Pumi Rat Terrier Redbone Coonhound Retriever Rhodesian Ridgeback Rottweiler Saint Bernard St. Bernard Saluki Samoyed Schipperke Schnauzer Scottish Deerhound Scottish Terrier Scottie Sealyham Terrier Setter Shar Pei Sheep Dog Shepherd Shetland Sheepdog Sheltie Shiba Inu Shih Tzu Siberian Husky Silky Terrier Skye Terrier Sloughi Smooth Fox Terrier South Russian Ovcharka Spaniel Spitz Staffordshire Bull Terrier Swedish Vallhund Terrier Thai Ridgeback Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Tosa Inu Toy Fox Terrier Treeing Walker Coonhound Vizsla Weimaraner Welsh Corgi Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Westie Wheaten Terrier Whippet White German Shepherd Wire-haired Pointing Griffon Wirehaired Terrier Xoloitzcuintle/Mexican Hairless Yellow Labrador Retriever Yorkshire Terrier Yorkie
Size *	Extra Large Large Medium Small
Age *
Date of birth if known
Description *
Reason for parting with animal, please be specific. *
Has the animal had frequent contact with children? *	NoYes
Has the animal lived with animals other than cats and dogs? If so, please specify *
Where does the animal spend their time during the day? *
Where does the animal spend their time during the night? *
Is the animal used to both men and women? *
Has the animal been neutered/spayed? *	Yes No Unknown
Has the cat been declawed? *	No Front paws All paws
Did you adopt this animal from the Humane Society of Barron County *	NoYes
If yes, what was this animal's name at adoption?
If no, where did you get the animal from initially?
How long has the animal lived with you? *
How would you describe your animal`s behavior? For example: bold, shy, timid, aggressive, affectionate *
What was the date of your animal's last vet visit?
Who is your primary veterinarian or vet clinic? *
Has your animal had any previous operations or treatment for medical conditions? *
Do you have vaccination records for the animal? *	NoYes
Does your animal have any known allergies? *
Behavior
Has this animal ever bit anyone? *	NoYes
If so, did it break skin and when did it occur? *
Has he/she any unusual behavioral habits? *
Has the animal ever been destructive in the house? Please describe *
Owner information
Person providing information	Owner Inspector Owner's representative
First name *
Last name *
Address *
City *
State *
Zip Code *
Phone Number *
Email Address
Confirm email