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OUTREACH QUESTIONNAIRE

 

In order to process your relinquishment request, we must receive this completed form along with photos of the dog you wish to relinquish.  Photos must be sent as soon after submitting the form as possible.  All photos should be taken within five (5) feet of the dog at the dog's level.

Three poses will need to be taken...
1) full body shot of left side while standing
2) full body shot of right side while standing
3) front face shot.
If the tail is not visible in either of the side views, please include a picture of the dog from the back, so that the tail is in full view.


Upon submitting this form, please send your dogs photos to Info@SouthwestCairnRescue.com.  The sooner we receive your dogs photo's the faster we can help.
 

Date:

Dog's name:

Has the dog ever bitten anyone?    If yes, please explain

 

Owner Information

Your full name:

Address:

City, State, Zip:
   

Phone (H):

Phone(W or cell):

Email address:

How long have you had the dog?

Where was the dog purchased?

If from a breeder, please list name and phone number.

Name of your vet.
Vet Phone

Physical description of the dog.

Is the dog a purebred Cairn Terrier or mix?    If purebred, do you have any papers?

Age:

 

Height:

 

Weight:

 

Color:

 

Sex:

 

Is the dog spayed or neutered?

 

Is the dog current on vaccinations including rabies?

 

Has the dog been tested for Heartworm?

 

If so, is it currently on heartworm prevention?   

 

 

How does the dog react to:

 

     Other dogs

 

    Cats

 

     Strangers

 

     Men

 

     Women

 

     Children

 

     Crates

 

     Car Rides

 

 

Does the dog pull when walked on a leash?

 

Is the dog afraid of storms?

 

Does the dog show any aggression if approached when he/she is eating?

 

Is the dog housebroken?

 

Does the dog come when you call it?

 

Please list any behaviors that your dog needs improvement ex. barking, jumping on people, runs away, fearful of mower/vacuum, etc.):

 

Why are you surrendering the dog?

YOU MUST AGREE TO OUR OUTREACH TERMS   AND THAT SOUTHWEST CAIRN RESCUE WILL PERFORM ALL COMMUNICATIONS BETWEEN OWNER AND ADOPTER AS WELL AS FACILITATE THE TRANSFER OF DOG TO THE NEW OWNER. PRIOR TO PRESSING THE "SUBMIT" BUTTON BELOW.  PLEASE CHECK HERE  THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO OUR OUTREACH TERMS, ARE THE LEGAL OWNER OF ABOVE DOG AND ARE AT LEAST 21 YEARS OF AGE.


 

 

Website: Webmaster@SouthwestCairnRescue.com

email: Info@SouthwestCairnRescue.com

Southwest Cairn Rescue 2005 | All Rights Reserved

 

All volunteer, not-for-profit 501(c)(3) organization

dedicated to rescuing Cairn Terriers.

 

Southwest Cairn Rescue

P. O. Box 2728

Orange, CA

92859