Name *
Street Address *
City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code *
Home Phone Number *
Email Address *
 

Please tell us about your Lab.
Lab's Name * Color *
Gender *MaleFemale Age * Was this Lab a Stray? *YesNo
Is this an indoor Lab? *YesNo If no, where is the Lab kept?
Good with other dogs? *YesNo Good with kids? *YesNo Good with cats? *YesNo Housebroken? *YesNo
Purebred? *YesNo Registration Papers? *YesNo
Any notes on Lab's basic characteristics

Is this Lab used to being *PetHunterBreeding StockWatch DogObedience DogOther
How long have you had this Lab? *
Have you seen ANY aggression EVER? If yes, describe *
List all the dog's habits, good or bad *
Has the Lab had Leash/Obedience Training? *NoYes, BasicYes, Advanced Crate/Kennel Trained? *YesNo
What type of yard is this dog used to? *Fenced Yard, Under 6' FenceFenced Yard, 6'+ FenceUnfenced Yard Has this dog ever jumped a fence or run off when off-leash? *YesNo
What food are you currently feeding? *

Medical History
Do you have all vet records? *YesNo Vet's Name & Phone Number *
When were last vaccinations given? * When neutered/spayed? *
When last tested for heartworms? * When last heartworm medication given? *
What type of heartworm medication? *
List any other medications Lab is currently taking *
Height * Weight *
List ALL known medical conditions *
List any prior medical conditions *
Any known allergies? If yes, please list *

Why are you giving this Lab up? *

Please understand, this does NOT mean we will be taking possession of your dog; since we have so few fosters, we will ask you to keep your dog until we find a loving home for her/him.  This can take a while, so please be patient.

Disclaimer: All of the above information is true and up to date as possible. Any discovery of false or misleading information could result in legal action against you as the initial owner of this dog.

There is a Surrender Donation of $25. This is to be paid BEFORE we process the intake of your dog.

By signing below you acknowledge that you understand and agree fully with this disclaimer statement and that you have answered truthfully.
Signature * Date *