Dog Intake Form
Email address *
Owner Name
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Address
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City
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State
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Zip Code
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Phone Number
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Dog Name
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Does anyone else have an ownership interest in this dog? If yes, please provide the name, address and telephone numbers of each person:
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Breed
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Age
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How long have you owned this dog?
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Sex
Weight
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Color and Markings
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Did you purchase from a breeder? If yes, name of breeder. If not, where did you purchase dog?
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Neutered or Spayed?
Veterinarian Name and Phone Number
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Has the dog received DHLPP, bordetella and rabies vaccines in the past year? Can you prove it?
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Will you provide vet records?
Does the dog have any physical problems?
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Does the dog have any allergies?
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Is this dog on medication? If yes, what?
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Does the dog have any obedience training? If so, what school/trainer?
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List commands, skills, tricks:
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Is the dog house trained?
Is the dog crate-trained
Who in the family does the dog obey?
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Where does the dog typically spend the day?
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How does the dog react to other dogs?
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How does the dog react to cats?
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How does the dog react to strangers?
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Has the dog lived with children? If yes, what ages.
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How does the dog react to walking on a leash?
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How does the dog react to being alone in the yard?
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How does the dog react to being alone in the house?
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How does the dog react to surprises?
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How does the dog react to loud noises?
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Does the dog bark excessively?
Does the dog dig?
Does the dog jump fences?
Does the dog chew?
Does the dog show shyness?
Does the dog fight with other dogs?
Does the dog growl when you take away food/toys?
Does the dog snap or nip at people? If yes, please describe.
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Does the dog show fear of men or women?
Does the dog show fear of children?
Has the dog injured or killed another dog or other animals? If yes, please describe.
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Has the dog ever bitten a person? If yes, please describe. (Did the wound require medical attention? Was it reported to animal control?)
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What does the dog like best?
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What does the dog fear the most?
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Why is the dog up for adoption?
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I, ________________________________, hereby make available for adoption through Knox Lab Rescue this Labrador Retriever named _______________who is (age) _________. I certify I am the owner of this dog, free and clear of all other interests. I certify that this dog is not possessed of any dangerous or vicious propensities and I have not willfully concealed information about this dog that may 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 Knox Lab Rescue, its Board of Directors, foster home providers, volunteers and agents 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 of the above named dog, and/or any harm or injury caused by such dog as a result of our offering such dog for adoption, or whatever kind or nature. I further understand and acknowledge that: (1) Despite my offering this dog for adoption, no such adoption may prove possible for this dog because of either terminal illness causing pain or over-aggressiveness toward people that cannot be cured; (2) Knox Lab Rescue may have no choice but to put this animal to sleep should either of those conditions obtain; and (3) my above release, discharge and agreement to hold harmless and indemnify Knox Lab Rescue, its Foster Home Providers, Volunteers, and agents will also extend to, and cover, those events that may occur after I have delivered this animal to Knox Lab Rescue for adoption through and until such time as this dog is put to sleep if adoption proves not to be possible for either of the above reasons. (Sign Your name, Dogs name and Date)
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