First Name*

Last Name*

Email*

Cell Phone*

Canine's Name:*

Status:*
Choose one: Adoptable In treatment Pending adoption Pending transfer

Canine's Gender:*
Choose one: female male

Birthdate (if known)

General age:*
Choose one: Baby Young Adult Senior

Years:

Months:

Days:

Primary Breed:*

Secondary Breed:

Mixed Breed?*
Choose one: yes no

Altered:
Choose one: yes no

Condition:*
Choose one: Healthy Treatable Untreatable

Heartworm status:*
Choose one: Negative Positive Not tested

Any special needs?*
Choose one: None On-going medication Special diet required Amputation Blind Hearing Impaired Has Allergies Drools excessively

Any medical treatment needed?

Current size (lbs)*

Size potential (general):*
Choose one: small medium large x-large

Primary color:*

Secondary color:

Color pattern:
Choose one: Bicolor Tricolor Brindle Merle Patches Spots

Distingishing Marks:

Eye color:
Choose one: Brown Black Blue 1 Brown and 1 Blue Amber

Ear type:
Choose one: Natural Cropped Erect Droopy Long Semi-erect Tipped Missing

Tail type:
Choose one: Long Docked Bob Curled Kinked Short Missing

Coat length:*
Choose one: Short Medium Long