First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Cell Phone

Owner's name

Dog's Name*

e-mail address*

Phone number*

Address: include street, city, state, ZIP code*

Gender

Is the dog *

First impression of animal - is it friendly? Aloof? Timid? Aggressive?*

General condition of animal - does it appear to have fleas? Are its eyes clear, hazy - is there discharge? Skin ok? Teeth ok? Hips ok? Touching ok? Temperament ok?*

Are there any issues, such as hot spots, matting?

Does the dog move stiffly? Have trouble getting up, walking?

When you give a dog a treat, can you see tartar, yellowing or missing teeth? How did the dog react to you? To eye contact? Did it pay attention, or was it aloof? Does it know any commands? Which ones? Did it take commands from you? Ask how the dog does with different types of people--fearful of men, children, other? Did the dog seem eager to engage or was it fearful, depressed?*

If you're able to walk him/her, how does the dog behave? If you can't, ask the shelter/owner for their evaluation.

What is the dog's activity level? Is there a connection to it's weight?

Can the dog be touched? Make sure it is safe! Check with the shelter/owner first. Let the animal sniff your hand before you try to pet them. Any growling or nervousness? Can you touch it's paws? Make sure NOT to bend over the dog's shoulders as this can be perceived as a threat.

Note if the dog shows any aggression. Can you tell why?

Describe any additional information about the home environment you feel is pertinent

Is there any information about previous owners, a breeder, general history, medical procedures, how the dog does at the vet? Boarding kennel? Daycare, dog park?

Is there anything in general or specific that would make you uncomfortable placing this dog with an applicant?

Recommendation:

Add any additional comments you may have

Evaluator's Name*