Make your own free website on Tripod.com

MID-ATLANTIC BLOODHOUND RESCUE RELINQUISH FORM

In an effort to help us place your dog in an environment best suited to his/her needs, please fill out the following questionnaire as completely and honestly as possible.

Name:    _____________________________________ Date: _____________

Address: ___________________________________________________

City: ________________________ State: ________ Zip Code:________

Home Phone: ________________ Work Phone:___________________

Email Address: ___________________________

Dog's Age:____  Dog's Sex: M   F     Altered? Yes  No

Dog's Name:_________________________

Reason For Giving Dog Up:___________________________________________

________________________________________________________________

________________________________________________________________

Dog's Temperament: ________________________________________________

_________________________________________________________________

_________________________________________________________________

Description that best fits your dog's temperament: (circle one)

Active Aggressive                    Timid Puppy Like                 Alpha Passive

Demanding                 Uncontrollable                   Shy                    Gentle

Has the dog ever bitten? _____________  Under what circumstances?

________________________________________________________________

________________________________________________________________

Does the dog ever growl, show his teeth, or snap? Under what conditions?

________________________________________________________________

________________________________________________________________

If you work, how many hours is this dog left alone? _________________________

Is the dog given free run of the house, or confined to a room or crate when left alone?

________________________________________________________________

_________________________________________________________________

Is the dog housebroken?______________________________________________

Does the dog bark excessively? _________Under what conditions?

_________________________________________________________________

_________________________________________________________________

Is your dog a digger or chewer?_________________________________________

How is the dog with children?___________________________________________

How is the dog with other dogs, cats and other animals? ______________________

_________________________________________________________________

How is the dog with strangers? _________________________________________

_________________________________________________________________

How is the dog with visitors? ___________________________________________

Is this dog leash trained? _____________________________________________

Is this dog obedience trained? _________________________________________

Does this dog have any formal SAR dog training? If so, when, where, and by whom was this dog trained by? __________________________________________________

_________________________________________________________________

General Over All Health (eye problems, skin problems, ear infections):

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Date of last DHLP-P? __________________  Date of last Rabies?______________

Date of last fecial test? ____________ Date of last heartworm test?______________

Type of heartworm preventative the dog is on?______________________________

Date heartworm preventative last given?___________________________________

Name, address, and phone number of veterinarian: ___________________________

_________________________________________________________________

_________________________________________________________________

Where did you obtain your bloodhound from? _______________________________

_________________________________________________________________

How long have you owned the dog? ______________________________________

Does the dog stay outdoors or in the home? ________________________________

If outdoors, how is the dog confined (kennel run, fenced yard, chained up)?

_________________________________________________________________

If the dog is confined to a fenced yard, what size and type fence?________________

_________________________________________________________________

Does the dog dig under the fence, climb over or jump it? ______________________

_________________________________________________________________

What should a potential new owner know about this dog before adopting him/her?

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Mid-Atlantic Bloodhound Rescue runs on donations only. We do ask that you supply a bag of food your dog is presently eating. Any donations you wish to make when relinquishing the dog would be greatly appreciated. MABR can always use toys, crates, food, dog bowls, brushes, leashes and other supplies.

Please print out form and mail to:

Mid-Atlantic Bloodhound Rescue

1963 Hayes Rd.

Gloucester Point, VA 23062

Or print and Fax to:

(804) 642-1857

Back to MidAtlantic Bloodhound Rescue

SouthEast Rescue | SouthWest Rescue | SouthCentral Rescue

NorthWest Rescue | NorthEast Rescue | ATHFAR Rescue

home.gif (1649 bytes)