Dog Owner Questionnaire - Part I
Dogs can't talk, so they can't tell us where or whom they would like to live.  To ensure that their home is a safe, happy and appropriate place we need you to fill out this form in as much detail as possible.  Detailed and honest information from you is crucial to the process, so please fill this out with care and accuracy.
Because of the length of this form it has been broken into several sections.  Please continue through all until you receive the final confirmation.

Your name  *		Email Address  *
Address  *		Phone  *
		Cell
Owner name (if different)
We are a 501(c)(3) non-profit organization.  The adoption donation is used to partially recover the costs involved in rescuing this dog. These costs include but are not limited to: Shelter fees, spay/neuter, food, housing, vaccinations, de-worming, micro-chip, and any vet exams or medical care that the dog may have required.  We would not have been able to accept your dog without the adoption donation from another that came before him/her.   Are you willing and able to make the donation fee?  Yes   No  When thinking of what an appropriate donation may be consider your pet.  Here are some of our standard costs.  Spay is about $125, Neuter is $90, Dentals start at $100 and can go up from there.  A full round of vaccinations runs about $25.  These are just some of the basics.  If a dog is older there are additional blood panels that are required, other issues may require medication, surgery, etc..
ALL personal information is kept confidential.
Dog's Name:  *		Dog's date of birth, age, or approximate age:  *
Dog's sex:  *	MaleFemale	Is dog spayed/neutered?  *	Yes No
What kind of permanent ID does your dog have?    *        If Tattoo, where and what. If Microchip, what brand and number
Has your dog bitten anyone or any animal in the last ten (10) days?  *  If Yes, Please describe incident. Has your dog ever bitten anyone or another animal and drawn blood?  *  If Yes, Please describe incident. Why are you surrendering your dog?  *  Please explain in detail.
If we could help you resolve this issue would you be interested in keeping the dog? *        Yes No Have you tried to find a home for this dog on your own?   Please describe those efforts. How long have you owned the dog? Have you contacted any other rescue for help in re-homing your dog? Including yours, how many homes has this dog had? Where did you acquire this dog?

You will be taken to the next form in the sequence.

 

We can be contacted at 503-429-8019
Christy@DisplacedPetsRescue.com
between the hours of 10 AM to 6 PM
Please leave a message if I am not available.  Let me help.