NorthEast All Retriever Rescue
Dog Placement Application
Dog Name
Owner's Name
Breed (if mix, please indicate what the mix might be)
Purebreed or Mixed Breed?
Mixed
Purebreed
If possible, please send a digital picture of the dog to surrender@nearr.com.
Sex
Male
Female
Color
Spayed/Neutered
No
Yes
Age of Dog
Age at Adoption/Purchase
Weight of Dog
Where did you originally get your dog?
Breeder
Shelter/Rescue Group
Friend/Family
Pet Store
Kennel
Found/Stray
Your Name
Street Address
City
State
Zip Code
Home Phone
Daytime Phone
Email
How did you hear about NEARR?
Have you contacted (or are you going to contact) any other rescue organizations or shelters? (We can often work together to help find a place for your dog.)
If you are, please list them here, including some type of contact information.
The more we know about your dog, the better job we can do of finding the best possible home for it. Please answer the following questions as completely as possible.
Current family includes: (Please give children's ages)
Do you have other animals? (Please list type sex and age)
Does this dog like:
Water
Untested
Doesn't
Somewhat
Tolerates
Likes
Loves
Cats
Untested
Doesn't
Somewhat
Tolerates
Likes
Loves
Other Dogs
Untested
Doesn't
Somewhat
Tolerates
Likes
Loves
Children
Untested
Doesn't
Somewhat
Tolerates
Likes
Loves
Baths
Untested
Doesn't
Somewhat
Tolerates
Likes
Loves
Car Rides
Untested
Doesn't
Somewhat
Tolerates
Likes
Loves
Being Brushed
Untested
Doesn't
Somewhat
Tolerates
Likes
Loves
Strangers
Untested
Doesn't
Somewhat
Tolerates
Likes
Loves
Elaboration on Likes/Dislikes
Is this dog?
Housebroken
Unspecified
Yes
No
Crate Trained
Unspecified
Yes
No
Obedience Trained
Unspecified
Yes
No
Does this dog?
Chew
Unspecified
Yes
No
Bark
Unspecified
Yes
No
Jump on people
Unspecified
Yes
No
Dig
Unspecified
Yes
No
Come when called
Unspecified
Yes
No
Walk on lead
Unspecified
Yes
No
Does this dog know:
Sit
Unspecified
Yes
No
Stay
Unspecified
Yes
No
Heel
Unspecified
Yes
No
Down on Command
Unspecified
Yes
No
Fetch
Unspecified
Yes
No
Any special Training Tricks?
Household Activity Level
Quiet
Active
Very Active
Will this dog:
Jump 3ft fence
Unspecified
Yes
No
Jump 6 ft fence
Unspecified
Yes
No
Does not try to get out
Unspecified
Yes
No
Do you have a local Veterinarian?
No
Yes
Vet Name
Vet Address
Vet Phone
Vaccination dates:
DA2PP
Rabies
Bordatella
Corona
Last Test Date
Is this dog on heartworm treatment
No
Yes
If so, please list the type of heartworm preventative used
Please tell us about the dog
Feeding instructions
Meals per day
Amount per feeding
What is this dog's exercise/potty schedule
How does this dog notify that it needs to go outside
Where does this dog sleep
Where does this dog eat
Please describe this dog's general temperament
Has this dog ever snarled or snapped?
Has this dog ever shown fear?
Has this dog ever bitten a person or another dog?
Why are you unable to keep the dog?
Additional Comments
If your dog is registered with the AKC, please fill out this section out. Otherwise, press SUBMIT below
Dogs formal name
Dog's Nickname
AKC Number
Sire
Dam
Breeder/Place of purchase
Breeder Address