Registered Name:____________________________Call Name:________________

Sire:______________________________Dam:_______________________________

Birthdate:___________________Breeder:_________________________________

Sex:________Neutered:________Color & Markings:________________________
    (Attach photo-copy of registration or blue slip if available)

Date Acquired:____________________From Whom:__________________________

Address:__________________________Phone:______________________________

Shelter_______Placement_______Rescue_______Found________Other_________

Physical Condition: Height_______Weight____pounds (be exact as possible)

Coat Condition:___________________Apparent Injuries:__________________

Veterinary Evaluation:_______________________________________________*
    *attach written copy when available

Care Given: DHL [ ] Rabies [ ] Parvo [ ] Vet Exam [ ] Fecal [ ]
                 Vet Treatment [ ] Heartworm Exam [ ]

TEMPERAMENT: Reactions to: Food:____________________________________

Children:_______________________Adults (familiar)_____________________

Adults (strangers):_________________________Cars:_____________________

Shy?______________________Protective?________When?____________________

Where?___________________________Obedience Trained:___________________

Reaction to Discipline:_______________________________________________

Reaction to Other Dogs:_______________________________________________

Reaction to Other Animals:____________________________________________

Housebroken:______________Does he/she chew?________What?______________

Tendency to be destructive?________Of What?___________________________

Tendency to Chase?_____________What?__________________________________

What height fence does it take to confine this dog?___________________

Recommended type of placement (special conditions, use separate sheet if necessary)

__________________________________________________________________

__________________________________________________________________

Signature of Evaluator:_________________________________Date:_________

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Airedale Information

The ATCA Rescue & Adoption Committee fulfills the Airedale Terrier Club of America, Inc. ("ATCA") obligation to protect and advance the interests of the breed by providing services to lost, abandoned, abused or unwanted purebred Airedale Terriers.
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