Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Dog's Name
*
Dog's Age
*
Dog's Weight
*
Dog's Gender
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Male
Female
Where did you originally get your dog?
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How long have you had the dog?
*
Does the dog have any health concerns?
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Please list any and all medications for the dog
Is the dog on preventatives?
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Check all vaccines the dog has received
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Please list the dates vaccines and preventatives were last given
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Is your dog altered?
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spayed or neutered
Veterinary Office and Contact Information
*
I understand that I will need to call my vet's office to have the records released to Lucky 7 Dog Rescue.
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Check all that apply to the dog:
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Does the dog dig in the yard?
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Has the dog jumped a yard fence? Do you think they could?
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How does the dog react to riding in the car?
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Does the dog damage/destroy any of the following items?
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How does the dog react to being petted? By you and by strangers.
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Is there anything else that we should know about the dog's pet preferences?
How does the dog react to grooming such as baths and brushing?
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Check any areas the dog does not like being touched/is sensitive.
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How does the dog react to the food bowl being touched while eating?
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How does the dog react to a toy being taken away?
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Include any other command/obedience training you would like to share below.
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Is the dog used to being in a crate?
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Is the dog housebroken/potty trained?
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Yes
No
Is the dog leash reactive?
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Is the dog more sensitive or reactive on a leash?
On a scale of 1-5, how well does the dog get along with infants?
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On a scale of 1-5, how well does the dog get along with toddlers?
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On a scale of 1-5, how well does the dog get along with children?
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Ages 4-12
On a scale of 1-5, how well does the dog get along with teens?
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Ages 13-18
On a scale of 1-5, how well does the dog get along with men?
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On a scale of 1-5, how well does the dog get along with women?
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On a scale of 1-5, how well does the dog get along with strangers?
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On a scale of 1-5, how well does the dog get along with puppies?
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On a scale of 1-5, how well does the dog get along with small dogs?
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On a scale of 1-5, how well does the dog get along with big dogs?
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On a scale of 1-5, how well does the dog get along with cats?
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On a scale of 1-5, how well does the dog get along with small animals?
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Birds, reptiles, etc
If you selected 0-3 for any of the above, please describe how your dog reacts here.
Describe any other quirks/preferences for the dog's relationships.
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What does your dog enjoy?
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What is your favorite thing about the dog? What fun thing can we share with potential fosters/adopters?
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Has the dog ever been declared dangerous or potentially dangerous?
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If yes, please provide the following information:
City
County
Date
Details
Check all that apply regarding your dog's bite history.
*
Again, please be as truthful and objective as possible.
If you checked yes to a bite, please rate/check the worst bite:
If the dog has been involved in a biting incident, please provide any relevant details here.
Details can include age of children involved, breed of dog involved, etc. Please provide as much detail as possible. It is extremely important you be as truthful and objective as possible.
What, if any, circumstances would allow you to keep the dog?
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Please explain your reason for the surrender request.
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Understand that we cannot guarantee that Lucky 7 will be able to take your dog into the rescue. We are an entirely volunteer and foster based rescue with limited resources.
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You will send recent photos to canineclassifieds@lucky7dogrescue.com.
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By electronically signing, you agree that all information is accurate to the best of your knowledge, and you understand that once the dog is in the care of Lucky 7 Dog Rescue they can no longer be returned under any circumstances.
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