Date: _______________________   

DOG INFORMATION:

Sex: M/F    Altered: Y/N    AKC#__________________________

Dog's registered name:______________________  

Call name:_________________________________

Age:  ______________________ Date of birth: ___________________

OWNER INFORMATION:

Name of person surrendering dog:______________________________________  

Home phone: ___________________________  

Work phone:  _____________________________

Address: __________________________________________________________

_________________________________________________________________

How long have you had the dog?  ________

Your reason for surrendering the dog


BREEDER INFORMATION:

Was the breeder contacted? _______

Breeder's response __________________________________________________

Breeder name _____________________________ Phone ___________________

HEALTH RECORD:

Veterinarian _______________________________ Phone ___________________

Address ____________________________________________________________

Date of last vaccinations:_________ Rabies _________ Heartworm check ________      

Is the dog currently on heartworm preventative? ____________

Health problems _____________________________________________________

PREVIOUS HABITAT:

        Inside:  House ____ Apartment ____ Fenced Yard ____ Dog Door ____

        Outside:   Chained ______ Fenced Yard ____ Dog Run ____ Ran Loose ____

House trained: Y/N    Crate trained: Y/N    Leash trained: Y/N    Barker: Y/N

Rides well in car:  Y/N     Digs: Y/N     Dog aggressive: Y/N     Jumps fence: Y/N 

Destructive in house: Y/N    Only When Alone Y/N    Anytime Y/N

MISCELLANEOUS:

Type of dog food:__________________  Feeding per day: AM___ PM___ both___

Who fed the dog:  ___________________________________________________

Current family members and ages

____________________   _____             ____________________    _____

___________________    _____             ____________________    _____

Does the dog dislike: Men Y/N    Women Y/N    Children Y/N    Dogs Y/N    Cats Y/N

Has the dog e?er attacked another animal:  Y/N    If so, what were the circumstances:

Has the dog ever bitten anyone?  Y/N    If so, what were the circumstances:


Has the dog ever attempted to bite anyone?  Y/N   

If so, what were the circumstances:


LIVING WITH THE DOG:

Has he had run of the house ? ________  Allowed on furniture ? _________

Where did he sleep ? ______________   Does he have dog bed ? _________

Does he know any obedience commands ? ________________________________

Does he have any fears ? ______________________________________________

Does he talk or growl ? ______ Under what circumstances ?___________________

What does he enjoy most ?_____________________________________________

Is there anything the new owner should not try with the dog ? ________________

Is there anything you don't like about the dog ? ____________________________

Please supply any records you have on the dog such as pedigree and vet records

Rescue does not buy or pay for dogs. This is a service to help place Airedales in new homes when their present owners can no longer keep them. This service is free, however a donation to help pay for expenses is appreciated.

Donate with PayPal or Credit Card

 

Click here for other ways to donate

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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