Transfer Request - Pacific Northwest Cattle Dog Rescue

Dog's Name: *

Age:

Weight:

Breed(s):

Check all that apply: *

Date the dog was acquired:

How was the dog acquired?

Stray
Owner Surrender
Transfer
Other:

If owner surrender, why was the dog given up?

Has the dog been adopted and returned?

Has this dog ever bit an adult or child? *

Please describe incident(s) and any reports that were filed. *

What has been the highest level bite? *

Canine Bite Levels:

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Has the dog ever fought, killed, or injured another dog or animal?

If yes, please describe the incident(s).

Does the dog display any of these behaviors?

What is the dog's reaction to NEW PEOPLE?

What is the dog's reaction to NEW DOGS?

What is the dog's reaction to CATS?

What is the dog's reaction to CHILDREN?

What does the dog do if disturbed while sleeping or resting?

Does the dog need a muzzle?

Unsure
No
Yes, at these times:

Is the dog food motivated?

What's the dog's energy level?

Unknown
Low -- calm; not interested in sustained vigorous play
Medium -- enjoys socializing, chase or tug; can calm down naturally
High -- very engaged with owner; constantly bringing toys; never seems to tire

Is the dog afraid of any certain people? Noises? Situations? Movements?

Heartworm status *

Positive
Negative
Unknown

Date of Last Veterinary Exam:

Date of Rabies Vaccine *

Date of Distemper-Parvo Vaccine #1 *

Date of Distemper-Parvo Vaccine #2

Date of Distemper-Parvo Vaccine #3

Flea Preventative

First

Last

Heartworm Preventative

First

Last

Can PNWCDR be provided with a health certficate?

Yes
No
Unknown

Can PNWCDR be provided with proof of spay/neuter?

Yes
No
Unknown

Can PNWCDR be provided with a rabies certificate?

Yes
No
Unknown

Does the dog have any existing medical conditions?

Check all that apply

Has the dog exhibited any of the following symptoms in the past fourteen (14) days?

Check all that apply

Dog's Current Location *

First

Middle

Last

Where is the dog currently? *

Check all that apply

Is there a plan for transport to the Pacific Northwest (Washington or Oregon)? *

Check all that apply

Name *

First

Last

Phone *

Anything else for PNWCDR to know?

Shelter or Rescue *

Your Name *

Phone *

Email Address *

Email

Confirm Email

Date *

Thank you for helping us help Australian Cattle Dogs in need. Please complete this transfer request form to the best of your knowledge. Additional records can be sent to our intake team.