Dog’s Name______________ Age___ Sex___ Size___ Weight_____
Spayed/Neutered? Y / N How long have you had him/her?______
Bought as a puppy?______ Adopted at what age?_________
Address (If moving, please give new address as well) ______________________________________________________________ ______________________________________________________________
NOTE:Please notify the breeder, if available, before surrendering to rescue. All good, responsible breeders will want to take back any dog they’ve bred, regardless of age, for the privilege of placing that dog in a suitable new home themselves.
REASON FOR GIVING UP THIS DOG:______________________________________
Health Record: Please ask your vet for a copy of your pet’s complete medical history.
Dates of last:DHLP-P__/__/___ Rabies__/__/___ Bordetella__/__/___
Heartworm Check__/__/___ Currently on Heartworm Preventative?____
Brand____________________ Date last pill_______
Other Chronic Problems?_______________________________________________
Currently on any medication? If so, what and what for?_______________________
Diet: Brand of food___________________ How much and when fed___________
HOW YOUR DOG LIVED WITH YOU (Please check where applicable:)
Inside Dog: House___ Apartment___ Walked____ Tied out____
Fenced Yard___ Outside dog: Chained___ Fenced-Yard___ Dog Run___
Ages of all current family members:________________________________________
Has been exposed to and is good with :
Men___ Women___ Young Children___ Other Dogs___ Cats___
Has been: Housebroken ___ Crate trained ___ Leash trained ___
Obedience trained _____ Had run of the house____ Allowed on furniture ____
Had a dog bed_____
In what room did he/she sleep?__________
Where was he when no one was home?___________
Was he/she destructive? Yes___No___ If so, only when left alone?_____
Any fears?_____________________ Favorite toy/activity______________________
Is there anything the new owner should NOT try to do with the dog?____________ (Over)
Is there anything you DO NOT LIKE about this dog?___________________________
Does he/she ever snarl or growl?______
If so, under what circumstances?__________________________________________
HAS THIS DOG EVER BITTEN ANYONE? Y / N
IF SO, WHEN? (Date) _____/_______/________
WHAT WERE THE CIRCUMSTANCES?_______________________________________
Please bring all papers you have on this dog with you when you come to release him/her to Airedale Rescue. Although we do not give registration papers with our adoption dogs, it is helpful for our records to keep track of their origins. Please bring his/her health records and all veterinary certificates (such as rabies and proof of neutering) which are required to obtain proper licensing for the dog.
I certify that I am the legal owner of this dog, free and clear of all other interests.
On _________, 200__, I hereby transfer ownership of ________________________to
________________________ of the Airedale Rescue and Adoption.
I understand that every effort will be made to place my dog in the best home possible, suitable to his personality. I hereby relinquish all claims to said dog, and I understand that if the Airedale Rescue and Adoption Service concludes that this dog is unadoptable because of health or temperament reasons only, he/she will be humanely euthanized by a veterinarian.
I further certify that this dog has not bitten anyone within the last ten (10) days.
By my signature below, I hereby authorize the above-named dog’s veterinarians to release all medical records to _______________________ on request in person or via fax.
Signed:_________________________________ Date ____/____/______
Witness:_______________________________ Date ____/____/______
Every dog accepted by the Airedale Rescue and Adoption is properly clipped, bathed, brought up to date on all shots, checked for heartworm, neutered/spayed (if not already done), treated for any ailments including heartworm infestation, and kept in one of three foster homes available. Sometimes these foster homes are already filled, and one or more of the adoptable dogs have to be kept for a time in a local boarding kennel.
While an adoption fee helps to generally cover routine veterinary expenses, there are times when extra measures are required to medically make a dog acceptable for adoption, and certainly there is no money left from an adoption fee for boarding or advertising.
For these reasons, we humbly ask that you find it in your heart to help us with the financial burdens of placing your dog by giving a donation. Please make any checks payable to Airedale Rescue.
If you have any questions, please do not hesitate to call.
Airedale Rescue and Adoption: