Owner relinquishment

Date:

Dog's name:

Has the dog ever bitten anyone? Unknown No Yes    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.

Physical description of the dog.

Is the dog a purebred Cairn Terrier or mix? Unknown Purebred Mix    If purebred, do you have any papers? Unknown No Yes

Age:

Height:

Weight:

Color:

Sex: Unknown Male Female

Is the dog spayed or neutered? Unknown No Yes

Is the dog current on vaccinations including rabies? Unknown No Yes

Has the dog been tested for Heartworm? Unknown No Yes

How does the dog react to:

Unknown Friendly Shy Growls Aggressive      Other dogs

Unknown Friendly Shy Growls Aggressive     Cats

Unknown Friendly Shy Growls Aggressive      Strangers

Unknown Friendly Shy Growls Aggressive      Men

Unknown Friendly Shy Growls Aggressive      Women

Unknown Friendly Shy Growls Aggressive      Children

Unknown Enters easily Enters with help Will not enter Ok once inside      Crates

Unknown Enjoys Fine once in the car Gets sick Barks at other cars      Car Rides

Unknown No Yes Does the dog pull when walked on a leash?

Unknown No Yes Is the dog afraid of storms?

Unknown No Yes Does the dog show any aggression if approached when he/she is eating?

Unknown No Yes Is the dog housebroken?

Unknown No Yes Does the dog come when you call it?