• Canine Assistance Request Profile

  • Our Companions Animal Rescue is a 501c3 non-profit organization. The mission of Our Companions is to offer programs and services that support and nurture a positive relationship between people and their pets. Our Companions Community Canine Behavior Programs are specifically designed with the bond between people and their pets in mind. 

    Please complete this form to help us understand you, your dog, and any specific goals you have within our programs.

    If you are unsure if you are eligible for this program or require additional assistance, please do not hesitate to contact us at 860-242-9999 or Helpline@OurCompanions.org

    All forms will be reviewed within 5 to 10 business days. Pet guardians will be contacted if additional information is required or if there is a concern regarding program selection and/or availability prior to scheduling. 

  • Client Information

  • Format: (000) 000-0000.
  • I am completing this paperwork for:*
  • What Programs/Resources are seeking and/or interested in? Please select all that apply*

  • *Please Note: Our Companions does not offer public intake, owner surrenders, or canine rehoming. Our placement consultations are designed for pet guardians seeking an assessment of whether their dog can be successfully rehomed through traditional rehoming options in our community, what behavioral/placement considerations may be necessary, and what resources are available.

  • Dog Information

  • Sex*
  • Is your dog neutered or spayed?*
  • What is your relationship to this dog?*
  • Where did you get this dog from?*

  • Household Information

  • Does your dog live with other animals?*

  • Daily Life

  • Do you take your dog out to go to the bathroom?*
  • Does your dog USUALLY have accidents in the house?*
  • Where does your dog spend most of their time?*
  • Where is your dog when left alone?*
  • When left alone, does your dog USUALLY show any of the following behaviors? Check all that apply.*
  • Is your dog allowed on furniture?*
  • Where does your dog USUALLY sleep overnight?*
  • Does your dog have problems riding in the car?*
  • Has your dog ever been walked on a leash?*

  • Medical History

  • Has your dog seen a Veterinary Behaviorist or Behavior Specialist?*
  • Have you spoken to your general practice veterinarian regarding behavior?*
  • Does your dog have to muzzled at the veterinarian?
  • Has your dog shown any of the following behaviors while at the vet or groomers?*
  • Does your dog have any past or present medical conditions or injuries?*
  • Is your dog currently on any medication*
  • What types of food does your dog eat? Please check all that apply.*
  • Does your dog have any food allergies and/or are they on a special diet?*

  • Behavioral History

  • Has your dog had any formal training?*
  • Is your dog scared of anything?*
  • How does your dog USUALLY behave when meeting NEW people? Check all that apply.*
  • How does your dog USUALLY behave when greeting FAMILIAR/KNOWN people in the home or yard? Check all that apply.*
  • How does your dog USUALLY behave when an UNKNOWN person enters the home or yard ? Check all that apply.*
  • How does your dog USUALLY behave around FAMILIAR/KNOWN dogs? Check all that apply.*
  • How does your dog USUALLY behave around cats? Check all that apply.*
  • When on a walk, how does your dog USUALLY behave when they see a person? Check all that apply.*
  • Does your dog attempt to uncontrollably chase... Check all that apply*

  • Fear & Aggression

    When answering this section do NOT include aggressive behaviors towards veterinarians or groomers.
  • Has your dog ever inflicted a bite to a person that required medical care?*
  • Has your dog ever attacked another dog resulting in severe injury or death?*
  • Has your dog ever attacked a cat or domesticated animal resulting in severe injury or death?*
  • Has your dog ever chased and killed a small animal such as a squirrel, rabbit, or bird?*
  • Has your dog ever shown any of the following behaviors towards MEN? Check all that apply.*
  • Has your dog ever shown any of the following behaviors towards WOMEN? Check all that apply.*
  • Has your dog ever shown any of the following behaviors towards CHILDREN? Check all that apply.*
  • Has your dog ever shown any of the following behaviors towards another DOG? Check all that apply.*
  • Has your dog ever shown any of the following behaviors towards a CAT or SMALL ANIMAL? Check all that apply.*
  • If any aggressive behavior was checked above, was it.... (check all that apply)*
  • If a snap or bite occurred to a person, did this occur while breaking up a dog fight or while the dog was in severe pain?*
  • If a snap or bite occurred to a child, did this occur while breaking up a dog fight or while the dog was in severe pain?*

  • Adoption Follow-Up Survey

  • What program was this dog adopted from?*

  • Rabies Vaccination Agreement

  • Every dog participating in training programs at Our Companions Animal Rescue (OCAR) must be up-to-date on their Rabies Vaccination in accordance with Connecticut State Law. All clients are required to submit proof of vaccination before the first session. 

  • Is your dog currently Up-to-Date on their Rabies Vaccination?*

  • Photo Release

  • Photos and videos are often taken of participants and their dogs during training programs at Our Companions Animal Rescue and are often used in our social media posts, newsletters, promotional materials, websites, etc. It is important to us that we respect the safety, security, and personal rights of all of our community members.
  • Date*
     - -

  • Agreement to Hold Harmless

  • In consideration for participation in the training offered by Our Companions Animal Rescue (OCAR), I hereby assume all responsibility for any claim, loss or damage, of whatever kind or nature, whether to person or property, arising out of or related to this training. I further agree that I will hold OCAR, its officers, directors, trainers, volunteers, agents and members harmless and defend them from any and all liability for any injury, claim, damage or loss, of whatever kind or nature, whether to person or property, arising out of or related to this training. I agree to indemnify OCAR, its officers, directors, trainers, volunteers, agents or members who might be the subject of any claim, suit, loss or damage caused in any way by any act or negligence on my part or on the part of my dog during the Training Program.

    I acknowledge that while OCAR may facilitate and sanction this training, OCAR does not have and does not exercise control of the conduct of my dog(s). I further recognize that OCAR is providing this training as a community service and utilizes volunteer trainers with varying levels of training experience. I also understand that the degree to which a dog is successfully trained is a function of the interest, commitment, and cooperation of the owner. I acknowledge and agree that there is no guarantee that my dog will achieve the desired level of training, despite the best efforts of the instructor. I also acknowledge that all information I have provided is factual, complete, and honest.

  • Date*
     - -

  • Additional Notes, Photos, & Records

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