Canine Surrender Profile

Canine Surrender Profile

Idaho Humane Society
Dog and Household Information
Owner's name? *

First Name Last Name
Email *
example@example.com
What is your dog's name? *
What is your dog's gender? *

Male Female
How old is your dog? *
What is the breed of your dog? *
Is your dog spayed or neutered? *

Yes No Don't know
Where did you get this dog from? *

This shelter (Idaho Humane Society) Friend/Relative Newspaper/Website Found/Stray Breeder Pet Store Other shelter/rescue Other (please describe)
If from other shelter/rescue, please write name: *
Why are you surrending your dog? *
If our staff can provide resources or assistance to help you, would you consider keeping your dog? *

Yes No
If it is determined that your dog is not a candidate for adoption and will be euthanized, would you like to be notified? *

Yes No
Typical Behavior

Please describe your dog's usual behavior
Including yourself, how many people of the following ages live in your house? Please list the ages of MEN inside the home: *
Please list the ages of WOMEN inside the home: *
Please list the ages of children that are BOYS inside the home: *
Please list the ages children that are GIRLS inside the home: *
What other animals did your dog live with? *

No other animals in the household Dogs Cats Chickens/Poultry Rabbits/Small Animals Domestic Birds Horses Livestock Other (please describe)
How does the dog interact with these animals? *
How does your dog usually behave toward MEN your dog KNOWS: *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward WOMEN your dog KNOWS *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward CHILDREN your dog KNOWS *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward UNFAMILIAR MEN *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward UNFAMILIAR WOMEN *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward UNFAMILIAR CHILDREN *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward DOGS your dog KNOWS *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward CATS your dog KNOWS *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward OTHER ANIMALS your dog KNOWS *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward UNFAMILIAR CATS *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward UNFAMILIAR DOGS *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually behave toward UNFAMILIAR OTHER ANIMALS *

Never encounter Friendly Afraid Shows teeth/growls Snaps Bites Other (please describe)
How does your dog usually react when an unfamiliar person approaches or enters the yard or house? *

Friendly Afraid Barks Shows teeth/growls Snaps Bites Other (please describe)
Does your dog usually have "accidents" in the house? *

No Yes, please specify how often:
Would you describe these accidents as: *

Marking Not fully housetrained Behavioral (fear or excitement) Other (please describe)
Where do you leave your dog when it is home alone? *

Inside the house (runs free) Inside the house (in crate) Inside the house (confined to 1-2 rooms) Inside the house with access to yard via dog door Outside the house (runs free in the neighborhood) Outside the house (runs free in the yard) Outside the house (in kennel) Outside the house (tied) Other (please describe)
Describe your yard (check all that apply) *

Fully fenced, 6+ foot fence Fully fenced, 6 foot fence Fully fenced, 4 foot fence Partially fenced Unfenced Electric fence Chain link Wood Vinyl Iron Other (please describe)
How long is your dog left alone, without people, during each day? *

Never 1-3 hours 4-8 hours 9-12 hours Over 12 hours
Where does your dog usually sleep overnight? *

Crate Floor Dog bed Couch Owner's bed Outdoors (loose in yard) Outdoors (kennel) Other (please describe)
Tell us about your dog's "bad habits" *

Jumping Up Mouthy Plays roughly Excessive barking Digs holes Destructive Chases cars/motorcycles Chases cats/small animals Chases livestock Chases bicycles Jumps fences (please specify fence height) Barks at things when on leash Grabs food/items off counters/tables Chases people Urine marking Runs away Barks at things through fence Escapes (please specify how often) Other (please describe)
Please specify fence height that your dog jumps: *
Please specify details of how often your dog escapes? *
Is your dog allowed on furniture? *

Yes No
What commands does your dog know? *

Sit Down Stay Come Heel Shake No commands known Other (please describe)
Has your dog attended a formal obedience training class? *

No Yes (please provide trainer's name)
Is your dog scared of anything? (i.e. fireworks, thunder, certain objects) *

No Yes (please describe their reaction)
Does your dog have problems riding in the car? *

Don't know No Yes (please describe)
Describe how you provide physical exercise for your dog (please check all that apply) *

Play fetch Walk on leash Walk off leash Take to dog parks Doggy daycare Run together Play tug Take swimming Leave in backyard Wrestle Hunting Other (please describe)
How would you describe your dog's personality? (please check all that apply) *

Friendly Affectionate Loving Playful Quiet Cuddly Timid/Shy Calm Anxious Active Hyperactive Protective Independent Confident Submissive Fearful
What is your favorite thing about your dog? *
Aggressive Dog

Please list any behavior that has ever happened.
Has your dog ever fought with another dog? *

Yes No Don't know
Has your dog ever injured another dog? *

Yes No Don't know
Has your dog ever attacked another domesticated animal species (cats or livestock, but not "small pets" like hamsters, guinea pigs, etc.) resulting in injury or death to another domesticated animal? *

Yes No Don't know
Has your dog ever inflicted a bite to a person that has broken skin? *

Yes No Don't know
Has your dog ever shown aggressive behaviors towards MEN? *

Shows teeth/growls Snapped or lunged at Bite (did not break skin) Bite (broke skin) None of these
Has your dog ever shown aggressive behaviors towards WOMEN? *

Shows teeth/growls Snapped or lunged at Bite (did not break skin) Bite (broke skin) None of these
Has your dog ever shown aggressive behaviors towards CHILDREN? *

Shows teeth/growls Snapped or lunged at Bite (did not break skin) Bite (broke skin) None of these
Has your dog ever shown aggressive behaviors towards VETERINARIANS or GROOMERS? *

Shows teeth/growls Snapped or lunged at Bite (did not break skin) Bite (broke skin) None of these
Has your dog ever shown aggressive behaviors towards other DOGS? *

Shows teeth/growls Snapped or lunged at Bite (did not break skin) Bite (broke skin) None of these
Has your dog ever shown aggressive behaviors towards OTHER DOMESTICATED ANIMAL SPECIES (cat, livestock, etc.)? *

Shows teeth/growls Snapped or lunged at Bite (did not break skin) Bite (broke skin) None of these
Please explain the circumstances of the snap or bite. If you checked more than one bite in the answers above, please explain the circumstances of every snap or bite. *
Was the aggressive behavior over food? *

Men Women Children Dogs Not Applicable
Was it over bones, rawhides, or chews? *

Men Women Children Dogs Not Applicable
Was it over toys? *

Men Women Children Dogs Not Applicable
Was it over stolen objects? *

Men Women Children Dogs Not Applicable
While breaking up a dog fight? *

Men Women Children Dogs Not Applicable
When the dog was in severe pain? *

Men Women Children Dogs Not Applicable
Was it when the dog was disturbed while sleeping or resting? *

Men Women Children Dogs Not Applicable
Was it when an adult or child handled the dog (brushing, handling feet, bathing, teeth brushing, ear cleaning, etc.)? *

Men Women Children Dogs Not Applicable
Was it when an adult or child entered the house or yard? *

Men Women Children Dogs Not Applicable
Was it when an adult or child approached and reached toward the dog? *

Men Women Children Dogs Not Applicable
Medical History
Did your dog receive regular veterinary care? *

Yes No
Does your dog have any past or present medical conditions, medication, or special dietary requirements? *

No Yes (please describe)
Please feel free to tell us any additional helpful information about your dog:
Please feel free to upload a photo of your pet (optional)

Cancel of
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Canine Surrender Profile

Dog and Household Information

Typical Behavior

Aggressive Dog

Medical History