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Dog Intake

DOG INTAKE FORM

OWNER TURN IN APPLICANTS Please tell us as much as you can about the dog. We understand that you might not know or have information to some of the questions, however, we need to work together to give your dog the right home.

I. Dog Information

Rescue Recipient *Select the rescue which will receive this form.
Dog Name*Required Field *
Is this dog being posted as:*Required Field *
Shelter DogRDVG DogOwner Turn In
Comments
Spayed/Neutered*Required Field *
YesNoScheduled
Purebred/Mix & Breed
If mix, what breed?
Sex *Required Field *
MaleFemale
Activity Level*Required Field *
HIghModerateLow
Weight (lbs) *Required Field *
Age *Required Field * Numbers Only *
Age is:
WeeksMonthsYears

II. History

Dog History or Rescue Story

III. Medical Vaccinations

Health Status
ExcellentGoodFairUnder Vet CareMishap AccidentsSurgery Operations
1st DHLPP Vaccination 5 to 7 Weeks Date
2nd DHLPP Vaccination 8 to 10 Weeks Date
3rd DHLPP Vaccination 11 to 13 Weeks
4th DHLPP Vaccination 14 to 16 Weeks
DHLPP Vaccination Booster Date Yearly for the first 3 Years
DHLPP Vaccination Over 3 Years Booster Date Older than 3; Every 3 Years
Bordetella 11 to 13 Weeks Date
Bordetella 14 to 16 Weeks Date Recommended
Heart Worm Test Date 14 to 16 Weeks Recommended
Dog have a Microchip?
YesNo
Microchip Date Date done
Spay / Neuter Date done
Notes - Comments
Example: If the vaccinations are not given yet due to age or other reasons, please explain; Do you have the Microchip paperwork? If the dog is over 6 months and not fixed - will you be able to get it done?

Medical Medication & History

Current Meds
Worming, Heartworm etc
Health History
When the dog was rescued, any sores, cuts, infections etc
Under Vet Care Details - Thyroid, Seizures etc
Surgery Details
Did the dog have surgery when he-she was rescued?

IV. Behavior

Low Coach Potato
In house dog padsLet out in yardWalk once a dayWalk twice day Other
Moderate Active
Needs daily playActive with toysNeeds walk three times dayNeeds half hour walk Other
High Energetic
Needs hiking or runnerPlays hard and longNeeds walk four times dayAlways busy in and out doors Other
Low Coach Potato Explain
Type, Frequency
Moderate Explain
Type, Frequency
High Energetic Explain
Type, Frequency
Behavior with other dogs
Ignores, mild interaction, active all dogs etc
Behavior with kids
Ages, Frequency of Exposure
Behavior with cats
Number of cats, frequency of exposure
Food issues
Food protective people, dogs, children
House trained Unsure, some accidents, no accidents, alerts owner
Behavior in the car Good, needs work, no experience
Behavior in the Crate Good, needs work, no experience
Behavior on the Leash Good, needs work, no experience

V. Dogs Needs

Fears
Vet, men, thunder, hats, loud noises
Needs help with
MedicationLeash WorkExerciseMore TrainingFear of MenNeeds Chew BonesShould be only dogSeperation AnxietyDigsCuddleJumps Other
List Other Needs
What special needs must be considered?
Describe dog's personality; likes/dislikes
What would the perfect home look like?

Contact Information: Foster, Partner or Owner

Name
Email
Best Contact
CellHomeWorkText
Cell Phone
Home Phone
Work Phone

Kennel or Shelter Information

If you are not a kennel or shelter, you do not have to fill out this section. If you have rescued a dog from a kennel or shelter, please provide us with that information.

Kennel or Shelter Name
Contact Name
Best Contact
PhoneEmail
Phone
Email
Fax
Website Address

Vet Information

Vet Name
Contact Name
Best Contact
PhoneEmail
Work Phone
Email
Fax Phone
Text
Additional Information

Signature

First Name *Required Field *
Last Name *Required Field *
Your Email *Required Field *
Best Contact *Required Field *
CellHomeWorkEmailText
Cell Phone *Required Field *
Home Phone *Required Field *
Work Phone

Upload Photos of Dog - at least 2 photos must be full body

Photo #1
Photo #2
Photo #3
Photo #4
Photo #5
Photo #6
Photo or File #7
Photo or File #8
Photo or File #9
U-Tube Video#1
U-Tube Video#2
U-Tube Video#3

Verification

Please enter any two digitsExample: 12
This box is for spam protection - please leave it blank

NOT GONNA LIE

We NEED MONEY

SEND TAX-DEDUCTIBLE DONATION NOW

Transportation

$6,000

Vaccinations

$5,000

Medical Exams

$2,000

Foster Care

$3,000

Rehabilitation

$3,400

Surgery / Emergency Care

$2,700

estimated monthly costs based on several years averages

More Ways to Help

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Your soul will thank you for helping all these beautiful dogs find good homes!

Information

Pet Travel
Pet Friendly Rents
Adoption Checklist

Pet Travel
Pet Friendly Rents
Adoption Checklist

Medical

Clinic Locations
Vaccination Requirements
Microchipping

Clinic Locations
Vaccination Requirements
Microchipping

Support RDV

Membership
Sponsor a Dog
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Membership
Sponsor a Dog
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RDV Websites

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Rescue Me
Petfinder

Adopt-a-Pet
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Petfinder

Rescue Dog Village Guardian, Inc.

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Rescue Dog Village Guardian, Inc. is a 501c3 tax-exempt non-profit organization in the state of CT.

Rescue Dog Village Guardian, Inc.