Name
E-mail
Address
City
State
Zip
H Phone
W Phone

Tell us about your Shiba:

Name
Date of Birth

Is the dog... -Select- Purebred Mixed breed Don't know! If Mixed, with what breed?

Gender: -Select-MaleFemaleDon't know!

Is the dog Neuter/Spayed? -Select- Yes No Don't know!

 

Dog's Height

Dog's Weight

Coat color:: -Select- Red Sesame Cream Black & Tan Red headed Black & Tan Saddleback Pinto Don't know!

Is the dog Up to Date on Vaccinations/Shots?: -Select- Yes No Don't know!

Is the dog Heartworm Negative & on preventive medicine?: -Select- Heartworm Negative - on medicine Heartworm Negative - NOT on medicine Heartworm Positive Don't know!

        If dog is on preventive medicine, which brand?

           Please list any health problems or concerns you have, including allergies, sensitivities to food or medicine, etc:

                        

 

            What brand of food is dog currently eating?

                        

            Why does this dog need a new home?

                        

            How well does this dog get along with: Male dogs?

                        

            How well does this dog get along with: Female dogs?

                        

            How well does this dog get along with cats and other small pets?

                        

           How well does this dog get along with children? infants, toddlers, preteens, and teenagers?

                        

            How well does this dog get along with strangers?

                        

 

            Has this dog ever bitten anyone?  If so, please elaborate.

                        

            What is the dog's energy level?  -Select- Couch potato Daily/Occasional walks Jog/Hike Run/Non-Stop Exercise

            Is the dog housebroken?  -Select- Yes No Occasional accidents Don't know!

            Is the dog crate trained?  -Select- Yes No Hates the crate - goes "crazy" Howls/Cries/Whines but will quiet down Don't know!

            Does the dog walk well on a leash?  -Select- Yes OK, but pulls a little OK, but bites the leash No Can't put a leash on him/her Don't know!

            What commands does the dog know?

                        

            Is the dog a climber?  -Select- Yes No Don't know!

            Is the dog a jumper?  -Select- Yes - Jumps the fence Yes - "counter surfer" Yes - jumps up on people No Don't know!           

                        If you said the dog is a fence jumper, please describe your fence (height, material it's made of, etc)

                        

 

            Is the dog a digger?  -Select- Yes - Digs to escape (holes along fence) Yes - Ocassionally find holes (not along fence) Yes - s/he is trying to dig back to Japan :-P No Don't know!           

            Is the dog a barker?                           -Select- Barks/Whine/Howl/Cries all the time! Barks/Whines/Howls/Cries when separated/crated Barks/Whines/Howls/Cries for a reason (noise in middle of night, other dogs outside making noise, someone at door, etc) No, quiet dog Don't know!       

            Is the dog an escape artist?  -Select- Yes - Escapes often Yes - Always trying, but does not escape No Don't know!           

            Is the dog a door bolter?  -Select- Yes - Always underfoot & trying to push out the door Yes - Always ready to run, or attempts to make a run for it No Don't know!           

  

         Would you be willing to keep the dog at your home, while we look for a new home or until foster space becomes available?

                        

 

         By what date does this dog need to be in a new home or foster home?

                        

          From where did you get this dog?  -Select- Pet Store Directly from a Breeder From a friend From a previous owner you don't personally know (i.e. ad in paper) Found stray From SPCA, Humane Society, Animal Control, a Rescue Group Other   

                        If from a pet store or breeder, please list name of store below

                        If from a breeder, please list breeder's name, city/state, and breeder's kennel name below

                        If from SPCA, Humane Society, Animal Control, or Rescue Group, please list the name and city/state below

             Do you have registration paperwork for this dog?  -Select- Yes No What's that?   

            Do you have a pedigree for this dog?  -Select- Yes No What's that?   

            Is this dog microchipped/tattooed?  -Select- Yes - Microchipped Yes - Tattooed Yes - both No Don't know - never checked   

Comments/Questions