First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

How did you hear about us?*

How long have you owned this dog?*

Did you adopt this dog from TARA or another rescue group? If so, which one?*

If this is a stray, has it been scanned for a microchip? If so, what was the result? What attempts have been made to find the owner?

What is this dog's name?

What is this dog's breed, age and size (approximate weight)?*

Is this dog social with people? Does he/she get along with other dogs, cats and/or kids?*

Is this dog house-trained?*

Does this dog have any known health issues?*

Does this dog have any known behavior problems?*

Does this dog live primarily indoors, outdoors or both?*
Choose one: Inside Only Inside and Outside Outside Only

Is this dog spayed or neutered?*

Is this dog current on vaccinations?*
Choose one: Yes No

Is this dog kept on heart worm prevention?*

Why are you needing to rehome this dog?*

Can you foster this dog in your home until adopted?*

What is your deadline for rehoming this dog? (Please keep in mind that we are more likely to be able to assist you if you will be able to continue caring for this animal for any length of time.)*

Do you understand that there is a $30 surrender fee that will be collected at the time of intake? *