Dog/Other Animal Profile

Contact Information

First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
-

Email*

Home Phone

Work Phone
x

Cell Phone

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About You

Profile Form Date

Can you keep the pet until it is adopted?

Yes

About the Pet

Pet Name:

Rescue ID (EAPL admin use only)

Pet Gender

Male

Female

Pet Species:

Dog	Cat
Other

If other, please describe:

Foster (EAPL admin use only)

Does your pet have special needs

What Breed is your pet

Color (general):

Weight (pounds):

Birthdate (exact or estimate):

Age

Reason you are giving up the pet:

Did the pet come from out-of-state?

Yes

If so, which state?

Medical Information

Vet Name:

Vet Phone:

Is the pet spayed or neutered?

Yes

Alter date

When are the next shots due?

When is the rabies shot due?

Does the pet have any old injuries or health problems?

Yes

If yes, please describe:

Does the pet need any medication or special diet?:

Yes

If yes, please describe:

When was the pet usually fed:

AM	PM
Free Fed	Other

Living Environment

Pet Time With You:

Where Acquired:

Where Allowed:

Inside House	Car
Patio/Deck	Fenced Yard
Unfenced Yard

How much of the time was the pet outside?

How much of the time was the pet inside?

Where did you leave the pet when you were gone?

Where did you leave the pet when you were gone on holiday/vacation?

Hours Unsupervised:

Where does the pet usually sleep?

Is this pet a fence jumper?

Yes

If yes, how high is the fence?

If yes, of what material is the fence made?

Does the pet repeatedly escape from your yard (dogs)?

Yes

If yes, please describe:

If yes, when does the pet try to escape?

All the time	When left alone
Other

If other, please describe:

Training Type:

Obedience Training	Home
Professional	None

Does the pet know how to:

Sit	Stay
Lie down	Come

Does the pet do any tricks?

Is the pet house trained?

If not house trained, has the pet been seen by a vet to rule out physical issues?

Yes

Has Accidents:

Once a day	Once a week
Never	Every time the pet is inside

Is the pet crate trained?

Yes

(Dogs) Is the pet leash trained?

Yes

(Dogs) Lunges at Dogs When Leashed?

Yes

(Dogs) Lunges at People When Leashed?

Yes

(Dogs) Lunges To Play?

Yes

Behavior

Has the pet ever bitten, snapped or growled?

Yes

If yes, please describe:

Bad Habits:

what have you done to correct it?

Is a Barker:

Yes

Barks When:

Frightened by anything?

Aggressive Towards Anything?

Aggressive Towards:

Men	Women
Children	Wildlife
Male Dogs	Female Dogs
Cats

Gets Along With:

Male Dogs	Female Dogs
Cats (Indoor)	Cats (outdoor)
Birds	Poultry/Livestock

Gets Along with Comments:

Good With Children:

Yes

Good With Children Comments:

Is Overprotective:

Yes

Has Favorite Toys:

Yes

If yes, please describe:

Best Situation:

Administrative Use

EAPL Tag Number:

form completed

Yes

EAPL Representative Who talked to you:

EAPL Representative Comments:

*=required