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Shiloh Rescue Network
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We're
having some difficulties with our webhost so the data from this form isn't
If you have an ISSR registered Shiloh that you need to rehome, we're here to
help! 1. Are you certain you want to rehome your dog? We have resources to help with behavior, training and
other problems. Our first choice is always to help you with your work
better with your dog, rather than having to rehome your dog. 2. If you must rehome your dog, please fill out the following request for placement. We need as much information on the dogs as we can possibly get to insure a good match with the dog's future owner. As of October 22, 2004, no dogs will be posted on the Shiloh Rescue Network website without having this form completed. It would be a great help if you could provide a few good pictures of the dog also. Please e-mail them in .jpg format to Debbie AFTER you have sent in the following form.
Shiloh Rescue Network -- Placement Application
Are you the legal owner of this dog?
__No __Yes
* REQUIRED INFORMATION *Name: *Zip-code:
Dog's registered name: Call Name:
__Intact Female __Neutered Male __Intact Male
ISSR Registration Number: Date of Birth:
Was this dog sold to you as: __Breeding __Show __Upgradeable Pet __Non-Upgradeable
Pet
Is there a co-ownership on this dog that needs to be satisfied by law?
__No __Yes
Co-Owner Phone:
What color is the dog?:
__Plush __Smooth
Is dog tattooed or
microchipped? __No __Yes
If not purchased from a breeder, where did you
obtain this dog?
Name of your Veterinarian:
Phone: Date of the last visit to the vet:
Has this dog ever been vaccinated for rabies? __No __Yes When?
Date of last heartworm test? Positive Negative
If the dog is on heartworm preventative, what kind is it?
Does this dog have any known health
problems? Temperament & Training Information: Were there
any children in the home with the dog? __No
__Yes __
Protective __
Overly Protective __ Herded/Nipped
at them How was the dog's behavior with the primary owner, or the
one person it was most attached to? (check all that apply)
How was the dog's behavior with the visitors (adults and
children)? (check all that apply)
How was the dog's behavior with the delivery people, mail
carriers, people working in yard, on your house, etc? (check all that
apply)
Was this dog
kept primarily as: (check all that apply)
What type of training has the
dog had?
What type of environment was the dog raised in?
Did the dog live in a: __House __Condo/Townhouse __Apartment __Other (please specify):
Was the dog primarily kept: __Indoors __Outdoors __Both
Did the dog have access to use a doggy door from the house to the yard? __No __Yes Did the dog have access to play in a fenced yard? __No __Yes
Where did
the dog spend a majority of it's time? __Chained in the yard __ In a kennel run __Other (please specify):
If the dog
spent time in a fenced yard or kennel, what was the height of the fence at the lowest point (in feet)? Does the dog enjoy swimming? __No __Yes
Was anyone home all day long with the dog?
__No __Yes
What brand of food do you feed this
dog:
Has this dog ever bitten anyone? __No __Yes If so, Who? Was the bite within the last ten days?
__No __Yes Please check all that apply:
__Raised with Children (give ages below)
__Good with children
Please explain any exceptions to
items checked above or other behaviors we should know about (example:
fear of thunder) : Is this dog well behaved with and used to being handled by: __Veterinary staff __Groomer __Dog Walker __Pet Sitter
Is this dog:
What commands does this dog know? __Sit __Down __Stay __Come __Heel
What
tricks or other commands does this dog know?
How do you discipline this dog? __Yell
__Say No __Gentle hitting __Time
out in crate __Leash
corrections
Why
are you giving this dog up? Please use this area to provide any additional information that you feel would help us find a home for your dog.
I hereby state that I/we are the legal owner(s) of the above described dog and that there are no other parties that may have a legal interest in this dog. In that I can no longer care for this dog, I hereby request the Shiloh Rescue to assist me in the placement of this dog, understanding that by doing so I am relinquishing all claims to this dog. I understand that this surrender and release of my ownership rights in this dog is irrevocable. I state and affirm that to the best of my knowledge, the above information is accurate and complete, and that I have not failed to disclose any information about this dog that might result in the harm of any person or other animal. I understand and agree that if I have not made full disclosure about any known bites, I hold the Shiloh Rescue harmless and indemnify the Shiloh Rescue for any legal damages resulting from the dog’s undisclosed propensity to bite.
Please type your initials on the line to the left to signify your consent: _____Initial here) I understand and agree that I am requesting the assistance of the Shiloh Rescue to place this dog, via adoption, and that it is of my own free will and that such surrender does not constitute a sale. I understand and agree that I will receive no money or other compensation as a result of surrendering this dog.
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Dedicated to rescuing and rehoming original ISSR Shiloh Shepherds. |
Shiloh Rescue Network
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