DOG'S NAME: _______________ BREED:_______________ AGE: _____ SEX: M/F ALTERED: Y/N OWNER'S NAME:________________________________________ PHONE:_______________________ OWNERS ADDRESS:_____________________________________________________________________ REASON FOR FINDING YOUR DOG A NEW HOME: ____________________________________________ HOUSETRAINED: Y/N CRATE TRAINED: Y/N LEASHTRAINED: Y/N BARKER: Y/N DIGS: Y/N DOG AGGRESSIVE: Y/N JUMPS FENCE: Y/N OBEDIENCE TRAINED: Y/N SHOT RECORD:__________________________________ DEWORMED:________________ TYPE OF DOG FOOD:_____________________ FEEDING PERDAY: AM___ PM___ BOTH___ VETERINARIAN:_________________________ DOG DOES... Sleeps in house____ Sleep on bed or furniture____ Gets along with dogs__________________ Gets along with cats ___________________ Chews________ Ride well in car_________ Behavior with children________________ HAS YOUR DOG EVER ATTACKED ANOTHER ANIMAL: Y/N ATTEMPTED TO BITE: Y/N HAS YOUR DOG EVER BITTEN A PERSON: Y/N ATTEMPTED TO BITE: Y/N ANY KNOWN HEALTH ISSUES/PROBLEMS: Y/N IF YES, DESCRIBE: _______________________________________________________________ ANY KNOWN BEHAVIORAL/TEMPERMENT ISSUES/PROBLEMS: Y/N IF YES, DESCRIBE: _______________________________________________________________ OTHER COMMENTS ABOUT DOG:________________________________________________________ _________________________________________________________________________________
It is understood that Noah's B'ark does not buy or pay for dogs. This is a service to help place in new homes when their present owners can no longer keep them.
I certify that this dog is not possessed of any dangerous or vicious propensities, and that I have not willfully concealed information about the dog that might indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify Noah's B'ark Pet Rescue Organization from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the above named dog.
OWNER'S SIGNATURE:______________________________________________ DATE:__________