SUBMIT YOUR DOG FOR ADOPTION

*NOTE* There is NO guarantee that any dog submitted will be posted.

Please complete this entire form.  This information will be used to help place your dog.  Click on the "Submit" button at the bottom of the page when ready to send.

Please note, a picture of the dog MUST be included.  Please email it to the rescue coordinator at rescue@jnmrf.org or mail a snapshot with the dog's name on the back to:

JNMRF
PO Box 65
Mendenhall, PA 19357

Name: *

Street Address: *

City*


State*

Phone: *

Email: *

How would you like to be contacted?     Phone    Email

Dog's name:*
 

Dog's age: years  months

Sex:   male     female

How long have you owned this dog?  

Why are you placing this dog? (if more room is needed, please send separate email)

Is the dog spayed or neutered?   Yes   No   Approx. date?

Is the dog current on vaccinations?    Yes    No

Is the dog current on heartworm check/preventative?    Yes    No
What preventative is used/frequencey of use: 

Name of veterinarian or clinic currently seeing this dog:

Address of veterinarian or clinic?

Phone number of veterinarian or clinic

Does this dog have any known health problems?       Yes    No
      If yes, please describe:

Does this dog ride well in a car?   Yes    No

Does this dog have a favorite game?   Yes    No
    If yes, what is it? 

Is this dog a picky eater?     Yes     No

Is this dog currently left alone during the day?   Yes    No
    If yes, how long? 

Does this dog enjoy/tolerate being bathed?    Yes     No     Never tried

Does this dog enjoy/tolerate being brushed?  Yes    No    Never tried

Which of the following BEST describes this dogs attitude toward cats?
  Aggressive     Tolerant but not playful         Cautious/Reserved
                              Happy/Playful                   Unknown

 

Which of the following BEST describes this dogs attitude toward other dogs?
   Aggressive      Tolerant but not playful         Cautious/Reserved
                              Happy/Playful                   Unknown

 

Which of the following BEST describes this dogs attitude toward children?
   Aggressive      Tolerant but not playful         Cautious/Reserved
                              Happy/Playful                   Unknown

What ages of children has this dog lived with?
Ages 

Has this dog had an owner other than yourself?    Yes     No

In what city/state did you acquire this dog?
City   State

How did you obtain this dog?     Pet shop      Shelter     Stray
             Breeder    Gift     Newspaper     Other

If from a breeder, have you tried to contact them?   Yes    No
   What is the breeder's name and location?
   Breeders name
   Breeders location      City State
   Breeders phone number
   Breeders email address

Does this dog have papers?    Yes    No
       If yes, are you willing to provide a copy of the papers?    Yes    No

Is this dog primarily an inside or outside dog?     Inside       Outside
       If outside, how is the dog confined when out?    Physical fence      Tie out
             Electric fence      Not restricted       Other

 Has this dog had a problem with any of the following?
        Running     Straying      Fence jumping       Digging

Is this dog completely housebroken?     Yes       No      Partially
       If not, are there accidents?         Occasionally      Frequently

Has this dog ever been trained to use an indoor kennel/crate?    Yes    No

Does this dog bark when left alone?    Yes    No

Is this dog destructive?     Yes       No       Yes, if left alone

Is there anything you don't like about this dog?    Yes    No

Is there ANYTHING else a prospective adopter should know about this dog?
        Yes                          No
          If yes, please explain:


 
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