LISTING TO PLACE

DATE:_____________________

NAME:___________________________________________________ PHONE:________________________

ADDRESS:_________________________________________________________________________

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BREED:__________________ SEX: _____ COLOR:__________________ AGE:______ ALTERED:_______

CHILDREN AT HOME?________________ AGES:______________________________________________

DOGS REGISTERED NAME:_______________________________________________________________

DOGS CALL NAME: ___________________________ AKC#______________________________________

MICROCHIP# ____________________________________ TATOO ________________________________

BREEDER: ____________________________________________________________________________

HOUSETRAINED: ________ DIGGER: _________ BARKER: _________ CHEWER: _________________

BEHAVIOR WITH CHILDREN:_________________ BEHAVIOR WITH OTHER DOGS:_______________ BEHAVIOR WITH OTHER ANIMALS:_________________________________________________________

DOG AGGRESSIVE:_____________ ESCAPE ARTIST: _________________________________________

VETERINARIAN: _______________________________________________________________________

SHOT RECORD:_____________________________________________ HEARTWORM PREVENTION:____

REASON FOR PLACING IN NEW HOME:______________________________________________________

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DATE DOG MUST BE OUT OF PRESENT HOME:_______________________________________________

COMMENTS: _____________________________________________________________________________

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DISPOSITION OF DOG: ___________________________________________________________________

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RESCUE AGENT: _______________________________________________________________________