This form is to be used by those owners who wish to turn their dogs over to a Rescue Organization, or for Shelter Personnel to give a description of a dog that has been surrendered or turned in as a stray.  If you are in need of a printed form to use in the assessment of a dog, please use the printed version of this form.  Fill it out as completely as possible.   For the printed form, an address is included at the bottom for mailing.  For the on-line form, use the Tab Key to move between fields, then submit by clicking on the Submit Button at the bottom.  Someone from St. Bernard Rescue will contact you.

I request that owners who are surrendering dogs to be rehomed also surrender all toys, grooming supplies, crate, AKC registration, plus have their dogs' immunization records updated, and have the dog spayed or neutered if necessary.  If these aspects of the dogs' care have already been attended, consider a donation to help cover the dogs' additional requirements.   Remember that I'm trying to give your dog the very best care possible... I cannot afford to provide these things out of my own pocket, and having these items will make the transition to a new home much easier for your dog.

Do Not Write in This Box:

Date Surrendered: Surrendered By:
email address:
phone number:
city: state:

Reason for Surrender:

Breeder/Placement Background:

Age:    Color:

Sex: Male  Female      Altered: Yes No

Dog's Name:

Physical Description:

Physical Problems or allergies:

Veterinarian (name and address):

Is this dog on HW preventative? YES NO If so, what kind?

Dates of last immunizations received:

    DHLP-P/FVRCP      

    bordatella               

    wormer                     

    HW Screen    results:

fecal screen   results:

    rabies immunization

have skin irritations?   Y N  

Being treated for fleas? Y N 

Where did the dog recieve these? 

Has this dog been checked for hip dysplasia?  Y N  If yes, give results:

Please understand that the answers given in this section will help us to place this dog in an environment that meets its individual needs -- answering honestly will help to ensure that the dog remains in its new home.

How long has this dog been in your possession?

Has this dog ever run away?

Has the dog ever growled at or bitten a human?  Y N 

If YES, give circumstances:

If this dog is an owner-surrender, what family members is this dog used to (men, women, kids, cats, other dogs, etc.)?

In your care, how has this dog reacted to strange dogs?

cats? children? infants?

adults? walking on leash?

being alone in fenced yard?

being alone in house?

being alone in car?  being groomed?

having nails clipped? What does

this dog like best?

like least?

fear?

How does this dog react when unhappy?

when afraid?

How would you describe the dog's overall temperament
(check all that apply):      friendly         aggressive         shy         dominant        confident

Where is this dog used to spending its days?

Nights?

What dog food, and how much, does this dog eat?

How many times a day?

Any special feeding instructions?

Has the dog exhibited any food-related aggression with
humans? Y N  

Has the dog exhibited any food or other aggression
toward other dogs? Y N

Has this dog been through any kind of training? Y  N

If "YES," trainer name:

Organization/Individual School:

Type of training:

What commands or tricks does this
dog understand?

Would you characterize this dog as obedient? Y N

Why?

What behavior problems has this dog exhibited? 

escape artist             car chaser   animal/livestock killer

        excessive howling         excessive barking

chewing           digging                house soiling             

sound sensitivity         fear aggressive with dogs      

with humans       car phobia 

other:

Is the dog crate trained? Y N

Is there anything else you feel is important for us to know about this Saint: