ADOPTION APPLICATIONS
CANINE SURRENDER

Nobody knows your dog the way you do.

Thank you for filling out this form to help us care for your dog and match them with a new family. Operation Kindness does not euthanize animals for space or time. Behavioral and medical issues do not necessarily create problems, but failing to disclose them might. Your dog will undergo a behavior assessment and a brief health evaluation while you wait. We will let you know before you leave if your dog is adoptable under current Operation Kindness policies. Completion and submittal of this form does not mean we have agreed to accept your pet. Please ask if you have questions.

YOUR DOG’S HISTORY
Dog’s Name:
Dog’s Nickname(s):
Tell us what you like best about your dog:
Why are you surrendering your pet today?
If we could help you resolve the issues surrounding the surrender of your pet, would you be interested in keeping your animal?
If yes, please stop here and speak with a member of our Intake staff: 972 | 418-7297

Age or approximate age:
How old was this dog when you acquired him/her?
What is your Dog's current weight?
0 - 20 lbs.
21-40 lbs.
41-60 lbs.
61-100 lbs.
Is this dog a:
Male
Female
Unsure
Has this dog been spayed or neutered?
Yes
No
Unsure
Has this dog been microchipped?
Yes
No
Unsure
How long have you owned this dog?
Including your home, how many homes has this dog had?
Where did you acquire this Dog?
Operation Kindness
Another shelter
Found as a stray
Friend/Relative
Pet store
Breeder
Free-to-good-home ad
Born in my home
Other

MEDICAL HISTORY
Did this pet receive regular exams by a veterinarian?
Yes
No
Unsure
Does this animal have any medical conditions or previous
injuries that require special attention or a special diet?
Yes
No
Unsure
Explain:
How does this dog behave at the vet’s office?
Calm, relaxed
Anxious, but calms down
Anxious, growls
Anxious, tries to hide or escape
Has never been to the vet
Very stressed,
must be muzzled to avoid biting
Please check all conditions that your dog has been diagnosed with or has been treated for:

Allergies
Urinary Tract Infection
Skin Problems

Old injury
Epilepsy/Seizures
Thyroid Disease

Heartworms
Kidney Disease
Ringworm

Diabetes
Hip dysplasia
Liver Disease

Heart murmur
Arthritis
Obesity

Kennel cough

Other:

BEHAVIOR PROFILE
My dog knows: (check all that apply)

Sit
Stay
Come
Down
Heel
Shake
Fetch

Other:
Check all traits that best describe your Dog’s behavior:

Very energetic
Moderately energetic
Has one favorite person

Independent (a loner)
Friendly with everyone
Loves attention from people

Fearful
Reactive to strangers
Difficult to train

Talkative
Lazy – Couch Potato

Friendly/affectionate to family members but shy with strangers

Other:
What’s your dog’s favorite style of play (check all that apply)?

Very gentle
Enjoys playing fetch
Tries to herd children or pets

Likes to play with other dogs
Likes to play with toys
Will learn tricks for treats

Likes to push and shove
Tugs with toys
Wrestles with other dogs

Likes to run fast
Plays chase
Not very interested in playing

Jumps on people while playing
VERY energetic and rambunctious

Other:
Has this dog regularly been around children?
Yes
No
Not Sure
If yes, what age range of children:
0-2 years old
2-5 years old
6-10 years old
11-18 years old
How does this dog behave around children? (check all that apply)

Gentle, cooperative
Playful Calm
Avoids certain children in family

Protective
Fearful, hides
Nips, jumps on them

Easy for play to get out of control
Other:
How does this dog behave around adults in family? (check all that apply)

Friendly
Playful
Calm
Avoids certain adults in family

Protective
Easy for play to get out of control

Other:
Describe how this dog behaves when people come to visit: (check all that apply)

Quiet
Excited or friendly
Jumps up on them

Barks at doorbell or knocking at the door
Barks at people once they are inside

Runs and hides, doesn’t come out

Sticks close to family members while visitors are around

Starts out unsure, then gradually warms up and is friendly

Continually pesters visitors for attention

Friendly upon entry, then goes and lays down after the excitement is over

Protective, growls when visitors come near a family member

Other:
How does this dog behave around other dogs? (check all that apply)

Never been around other dogs
Friendly, no fighting

Fight over certain situations or possessions

Didn’t really care, ignored other dogs

Did not get along at all, constantly fought

This dog picked on other dogs

Other dogs picked on this dog
How does this dog behave around cats? (check all that apply)

Never been around cats
Friendly, no fighting

Fight over certain situations or possessions

Didn’t really care, ignored one another

Did not get along at all, constantly fought

This dog picked on cats

Cats picked on this dog
How does this dog behave on leash? (check all that apply)

Walks calmly, no pulling
Pulls occasionally, but mostly does well

Pulls constantly
Fights the lead, bites and struggles

No experience on leash
How does this dog ride in the car? (check all that apply)

Sits calmly
Barks at other cars, people
Curls up and sleeps

Shakes, drools
Enjoys the ride, looks out window
Crated while in car

Other:
Does this dog have any of the following behaviors you consider a problem? (check all that apply)

Barks too much
Jumps up on people
Jumps fences

Won’t come when called
Digging
Unable to housetrain

Fearful
Insecure, too needy

Aggressive with strangers

Aggressive with children

Too bold and rough to deal with, nips during play

Growls or attempts to bite when food, treats or toys are present

Unpredictable, sometimes becomes aggressive for no reason

Chews up household items

Under foot constantly

Breaks out of crates

Sprays/marks with urine inside the house

Chews up outdoor plants or outdoor structures

Barks or whines loudly for a long time when we are gone

Destroys items near front door when we are gone

Scratches woodwork, rips up carpet or destroys blinds near windows or doors

Problem behavior when alone

Runs away when escapes

Other:
LIFESTYLE & HOME LIFE
Was this dog: (check all that apply)

Indoors except to potty or take walks
Outside 24 hours a day

Outdoors during the day, indoors at night

In and out throughout the day:
hours outside:
hours inside:
This dog sleeps: (check all that apply)

Inside, on the floor
Inside, on a dog bed
Inside, on a chair or sofa

Inside, in bed with adults
Inside, in bed with children
In a crate

In a garage or barn
Outside, in a dog house
Outside, on ground or under porch

Is this dog house trained?

Yes, completely
No, has frequent accidents
Mostly, has occasional accidents

Used doggie door
Only has accidents when left alone for long periods
While outside, my dog was: (check all that apply)
No confinement, allowed to run loose
Privacy fence. How tall?
feet

Tethered (tied) by chain or cable
Chain link fence. How tall?
feet

In a dog run: size of run:
feet X
feet
Confined in garage

Other
Have you had any problems keeping this dog confined in the yard? (check all that apply)

No, stays in yard
Yes, jumps fence
Yes, digs to get out
Is this dog ever crated? (check all that apply)

No
Yes, for car rides
Yes, daily-from
to

Yes, when left alone for:
hours at a time
If crated, this dog: (check all that apply)

Type of crate:

Is calm, sleeps
Is anxious at first, then calms down
Is anxious at first, then calms down

Escapes from crate
Chews items he can reach outside the crate

Other:
What kind of exercise did this dog receive? (check all that apply)
Daily walk, on lead
Walked 1-3 times per week, on lead

Placed on cable or run outside
Put out in fenced yard

Play dates with other dogs

Plays actively with owners daily (e.g. fetch, tug, Frisbee, etc.)

Taken to off-leash park or the country to run loose for a period

Dog sports (e.g. Agility, flyball, dock diving, Treiball, obedience)

No regular exercise period

Are there any special habits you have with your dog? (check all that apply)
Give a treat before bedtime
Daily brushing

Give a treat when you leave the house

Give a treat when you come home

Rawhide, toy, kong in the crate

Go for a walk before bedtime

Other
Does your dog have any behaviors, quirks or habits that you are not fond of? (please describe in detail)
How did you try to correct this behavior?
Has this dog ever been aggressive towards people or animals? (check all that apply)
Yes, has attacked or bit people

Yes, has attacked or bit other dogs

Yes, has attacked or bit other animals (what kind of animal?):

Yes, has growled at or lunged at people

Yes, has growled at or lunged at dogs

Yes, has growled at or lunged at people

Yes, has growled at or lunged at other animals

No, has shown no aggression towards animals or people
DIETARY HABITS
What brand of food did this dog eat?
Premium brand (i.e.: Wellness, Science Diet, etc.)
Grocery store brand (i.e.: Purina, Old Roy)

Generic brand
Home cooked diet

Prescription Diet – which one?

Other
Which of the following does your Dog eat?
Dry food only
Canned food only
Combination of dry and canned

Table scraps
Home cooked diet
Other

Dog food rolls (i.e.: Natural Balance)

Do you feed your Dog treats?
no
yes
What Kind?
How often was this Dog fed?
Once daily
Twice daily
Food always available
Other
Please feel free to add additional comments below that you think would be helpful to shelter staff or potential adopters.
Upload a current photo of your Dog: adopters.

Signature
Date
Phone Number
Email Address
By signing this I'm confirming my animal has not bitten anyone in the past 10 days.
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Thank you for providing us with these details about your animal
and for trusting us with their care!