Dog Listing Agreement
Fill out once per dog

*Home phone:

Work phone:

Other phone:

Fax phone:

*Address:

*City:

*Zip:

*Email address:

*Name of dog:

Is dog co-owned? No Yes

How long have you owned this dog? years months weeks

*Is the dog a mix? Yes No Maybe

*Sex: Male Female

Dog's address (if at a different location from owner's above):

Breeder's name & address (if known):

Have you notified breeder about need for new home? Yes No N/A

Are AKC papers available? Yes No

If not from a breeder, list source & location:

If dog from shelter, did shelter request dog be returned to them? Yes No N/A

What brand food does dog eat?

How much does dog eat daily?

How many feedings/day?

List veterinarian (name, phone):

*Are shots up to date? Yes No Don't know

*Is dog spayed/neutered? Yes No Don't know

Does dog have any physical problems? Yes No Don't know

Allergies? Yes No Don't know

If unspayed female, when was her last heat cycle?

Pregnant now? Yes No Don't know N/A

Has had puppies before? Yes No Don't know N/A

If intact male, has he been bred before? Yes No Don't know N/A

Is he dog aggressive? Yes No Don't know

Does he roam? Yes No

Has dog had obedience classes? Yes No Don't know
If yes, what school/trainer?

Any other training?

Guard	Obedience	Agility
Tracking	Hunting	Other

If Other, describe:

Housetrained? Yes No Don't know

Crate trained? Yes No Don't know

Paper trained? Yes No Don't know

List commands, tricks, skills:

Who in family does dog obey?

Dog typically spends days (choose one) Crated Loose in house Basement Garage Fenced Yard Loose unfenced Tied out Kennel Run

Has dog injured/killed other animals? Yes No Don't know

If yes, describe

Has dog ever bitten a person? Yes No Don't know

If yes, describe

Did wound require medical attention? Yes No N/A

Was bite reported to animal control? Yes No N/A

Was dog quarantined? Yes No N/A

What caused this bite?

What does dog like best?

Dislike or fear most?

Why is dog up for adoption?

What is the most appealing thing about this dog?

What is the dog's biggest fault?

*Have you tried placing the dog yourself? (describe)

*Do you understand that all dogs placed by SCLRR must be spayed or neutered and up to date on their vaccinations? You will be requested to mail or fax copies furnishing proof of spay/neuter & vaccinations for this dog.
No Yes

*Do you understand that we may not be able to place this dog due to its age, health, physical condition, temperament, or lack of training?
No Yes

How did you hear about SCLRR?

*May we give out your phone number to approved applicants who may be interested in your dog? No Yes