Below are three areas for information on other members of your family. Please include all other adults , children and pets living in your home by clicking on the designated button.
Adults Are There Other Adults In The Home?* How Many?* Select Option 1 2 3 4
Adult 1 First Name*
Last Name*
Age Range* Select Age Range Age: 18-21 Age: 22-24 Age: 25-34 Age: 35-44 Age: 45-54 Age: 55-64 Age: 65-69 Age: 70-74 Age: 75+
Gender* Select Gender Male Female Non-Binary Prefer Not To Answer
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other Family Member Other
Please Describe*
Phone Number*
eMail Address*
Are They Employed?* Full or Part Time?* Full/Part? Full Time Part Time
Name of Employer*
How Long Employed There?* Select Timeframe Under 1 Year 1-2 years 3-5 Years 6-10 Years 11-20 Years 21+ Years
Are You In School?* Full or Part Time?* Full/Part? Full Time Part Time
Adult 2 First Name*
Last Name*
Age Range* Select Age Range Age: 18-21 Age: 22-24 Age: 25-34 Age: 35-44 Age: 45-54 Age: 55-64 Age: 65-69 Age: 70-74 Age: 75+
Gender* Select Gender Male Female Non-Binary Prefer Not To Answer
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other Family Member Other
Please Describe*
Phone Number*
eMail Address*
Are They Employed?* Full or Part Time?* Full/Part? Full Time Part Time
Name of Employer*
How Long Employed There?* Select Timeframe Under 1 Year 1-2 years 3-5 Years 6-10 Years 11-20 Years 21+ Years
Are You In School?* Full or Part Time?* Full/Part? Full Time Part Time
Adult 3 First Name*
Last Name*
Age Range* Select Age Range Age: 18-21 Age: 22-24 Age: 25-34 Age: 35-44 Age: 45-54 Age: 55-64 Age: 65-69 Age: 70-74 Age: 75+
Gender* Select Gender Male Female Non-Binary Prefer Not To Answer
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other Family Member Other
Please Describe*
Phone Number*
eMail Address*
Are They Employed?* Full or Part Time?* Full/Part? Full Time Part Time
Name of Employer*
How Long Employed There?* Select Timeframe Under 1 Year 1-2 years 3-5 Years 6-10 Years 11-20 Years 21+ Years
Are You In School?* Full or Part Time?* Full/Part? Full Time Part Time
Adult 4 First Name*
Last Name*
Age Range* Select Age Range Age: 18-21 Age: 22-24 Age: 25-34 Age: 35-44 Age: 45-54 Age: 55-64 Age: 65-69 Age: 70-74 Age: 75+
Gender* Select Gender Male Female Non-Binary Prefer Not To Answer
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other Family Member Other
Please Describe*
Phone Number*
eMail Address*
Are They Employed?* Full or Part Time?* Full/Part? Full Time Part Time
Name of Employer*
How Long Employed There?* Select Timeframe Under 1 Year 1-2 years 3-5 Years 6-10 Years 11-20 Years 21+ Years
Are You In School?* Full or Part Time?* Full/Part? Full Time Part Time
Children Are There Children In The Home?* How Many?* Select Option 1 2 3 4
Child 1 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary Prefer Not To Answer
Previous Experience with Dogs* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 2 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary Prefer Not To Answer
Previous Experience with Dogs* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 3 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary Prefer Not To Answer
Previous Experience with Dogs* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 4 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary Prefer Not To Answer
Previous Experience with Dogs* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Dogs Do You Now or Have You Ever Had a Dog?* How Many?* Select Option 1 2 3 4
Have you ever taken care of a dog before (ie dog walker, dog sitter, etc) or have any other dog experience?* Select Option Dog Walker Dog Sitter Other
Please Describe*
Dog 1 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of Another Dog Puppy of My Dog Shelter Rescue Stray Other
Please Explain*
Is Dog Still Living With You?* Which Years Owned*
How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation:*
Please Describe The Situation:*
Please Describe*
Breed* Select Breed Mix Mutt Dad Is the Milkman Heinz 57 Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Australian Shepherd Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Great Pyrenees Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Black Labrador Retriever - Chesapeake Bay Retriever - Chocolate Labrador Retriever - Curly-Coated Retriever - Flat Coated Retriever - Golden Retriever - Labrador Retriever - Nova Scotia Duck Tolling Retriever - Yellow Labrador Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli
Age Range* Select Age Range Baby ( 0 - 5 Months ) Puppy ( 6 - 24 Months ) Youth ( 25 - 60 Months ) Adult ( 61 - 108 Months ) Senior ( 109+ Months )
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Sociability* Select Sociability Very Social Social Somewhat Social Not Social
Sleeping Quarters* Select Sleeping Quarters In Bedroom In Kid's Room In Other Room In Garage Outside Inside & Outside with Doggie Door
Up To Date on All Vaccines?* Vaccinated Annually?* Up To Date on Heartworm Prevention for Every Season?* Is There Any Additional Information You Would Like to Add?*
Dog 2 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of Another Dog Puppy of My Dog Shelter Rescue Stray Other
Please Explain*
Is Dog Still Living With You?* Which Years Owned*
How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation:*
Please Describe The Situation:*
Please Describe*
Breed* Select Breed Mix Mutt Dad Is the Milkman Heinz 57 Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Australian Shepherd Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Great Pyrenees Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Black Labrador Retriever - Chesapeake Bay Retriever - Chocolate Labrador Retriever - Curly-Coated Retriever - Flat Coated Retriever - Golden Retriever - Labrador Retriever - Nova Scotia Duck Tolling Retriever - Yellow Labrador Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli
Age Range* Select Age Range Baby ( 0 - 5 Months ) Puppy ( 6 - 24 Months ) Youth ( 25 - 60 Months ) Adult ( 61 - 108 Months ) Senior ( 109+ Months )
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Sociability* Select Sociability Very Social Social Somewhat Social Not Social
Sleeping Quarters* Select Sleeping Quarters In Bedroom In Kid's Room In Other Room In Garage Outside Inside & Outside with Doggie Door
Up To Date on All Vaccines?* Vaccinated Annually?* Up To Date on Heartworm Prevention for Every Season?* Is There Any Additional Information You Would Like to Add?*
Dog 3 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of Another Dog Puppy of My Dog Shelter Rescue Stray Other
Please Explain*
Is Dog Still Living With You?* Which Years Owned*
How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation:*
Please Describe The Situation:*
Please Describe*
Breed* Select Breed Mix Mutt Dad Is the Milkman Heinz 57 Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Australian Shepherd Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Great Pyrenees Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Black Labrador Retriever - Chesapeake Bay Retriever - Chocolate Labrador Retriever - Curly-Coated Retriever - Flat Coated Retriever - Golden Retriever - Labrador Retriever - Nova Scotia Duck Tolling Retriever - Yellow Labrador Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli
Age Range* Select Age Range Baby ( 0 - 5 Months ) Puppy ( 6 - 24 Months ) Youth ( 25 - 60 Months ) Adult ( 61 - 108 Months ) Senior ( 109+ Months )
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Sociability* Select Sociability Very Social Social Somewhat Social Not Social
Sleeping Quarters* Select Sleeping Quarters In Bedroom In Kid's Room In Other Room In Garage Outside Inside & Outside with Doggie Door
Up To Date on All Vaccines?* Vaccinated Annually?* Up To Date on Heartworm Prevention for Every Season?* Is There Any Additional Information You Would Like to Add?*
Dog 4 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of Another Dog Puppy of My Dog Shelter Rescue Stray Other
Please Explain*
Is Dog Still Living With You?* Which Years Owned*
How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation:*
Please Describe The Situation:*
Please Describe*
Breed* Select Breed Mix Mutt Dad Is the Milkman Heinz 57 Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Australian Shepherd Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Great Pyrenees Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Black Labrador Retriever - Chesapeake Bay Retriever - Chocolate Labrador Retriever - Curly-Coated Retriever - Flat Coated Retriever - Golden Retriever - Labrador Retriever - Nova Scotia Duck Tolling Retriever - Yellow Labrador Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli
Age Range* Select Age Range Baby ( 0 - 5 Months ) Puppy ( 6 - 24 Months ) Youth ( 25 - 60 Months ) Adult ( 61 - 108 Months ) Senior ( 109+ Months )
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Sociability* Select Sociability Very Social Social Somewhat Social Not Social
Sleeping Quarters* Select Sleeping Quarters In Bedroom In Kid's Room In Other Room In Garage Outside Inside & Outside with Doggie Door
Up To Date on All Vaccines?* Vaccinated Annually?* Up To Date on Heartworm Prevention for Every Season?* Is There Any Additional Information You Would Like to Add?*
Other Pets Are There Other Pets In The Home?* How Many?* Select Option 1 2 3 4
Other Pet 1 Animal Type* Select Animal Type Cat Bird Small Animal Barn Animal Reptile
Pet's Name*
Sleeping Quarters* Select Sleeping Quarters Inside Outside Inside & Outside Own Enclosure Barn
Sociability* Select Sociability Very Social Social Somewhat Social Not Social
Is There Any Additional Information You Would Like to Add?*
Other Pet 2 Animal Type* Select Animal Type Cat Bird Small Animal Barn Animal Reptile
Pet's Name*
Sleeping Quarters* Select Sleeping Quarters Inside Outside Inside & Outside Own Enclosure Barn
Sociability* Select Sociability Very Social Social Somewhat Social Not Social
Is There Any Additional Information You Would Like to Add?*
Other Pet 3 Animal Type* Select Animal Type Cat Bird Small Animal Barn Animal Reptile
Pet's Name*
Sleeping Quarters* Select Sleeping Quarters Inside Outside Inside & Outside Own Enclosure Barn
Sociability* Select Sociability Very Social Social Somewhat Social Not Social
Is There Any Additional Information You Would Like to Add?*
Other Pet 4 Animal Type* Select Animal Type Cat Bird Small Animal Barn Animal Reptile
Pet's Name*
Sleeping Quarters* Select Sleeping Quarters Inside Outside Inside & Outside Own Enclosure Barn
Sociability* Select Sociability Very Social Social Somewhat Social Not Social
Is There Any Additional Information You Would Like to Add?*