Dog Personality Profile and ReleasePlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Terrier Name *AgeFull numbers, please.GenderMaleFemaleSpayed/Neutered:YesNoHeightWeightColorCoat TypeSmoothWireWhere Did You Get the DogBreederFriendLocal ShelterOtherIf Breeder or Shelter, Please NameIf Breeder or Shelter, Please Provide Phone NumberHow Many Homes has the Dog Had?Full numbers, please.Where is the Dog Kept During the Day?Inside ConfinedInside LooseOutside ConfinedOutside LooseOutside TiedOutside KennelOtherIf Other, Please ExplainWhere is the Dog Kept at Night?Inside ConfinedInside LooseOutside ConfinedOutside LooseOutside TiedOutside KennelOtherIf Other at Night, Please ExplainIs the Dog Housebroken?CompletelyAlmost (being trained)Paper TrainedCrate Trained“Marks” TerritoryDoggie DoorNot TrainedIs the Dog Crate Trained?YesNoDoes the Dog Like the Car?Rides WellAfraidIn the Crate OnlyGets CarsickVeterinarian NameVet Address (Street, City, State, Zip)Vet PhoneDate of Last Visit and ReasonVaccinations (check if yes and current)RabiesDA2PPBordatellaPlease list any other vaccinations.Describe any Special Medical Problems or ConditionsType of Household Dog is Used toQuietFairly QuietBusyVery BusyCheck any Items the Dog is Protective ofFood BowlToysRawhide/bonesFurniturePeopleOtherPlease list any other things the dog is protective of.Dog is Protective of Above Item(s) WithOther animalsChildrenAdultsPeople and animalsHas the Dog Ever Bitten Anyone?YesNoIf yes, Please Describe the SituationDid the Bite Break the Skin?YesNoDid the Dog BiteAdultChildIf the dog bit a child, please list the approximate age of the child.Which Behavior Describes Your FT with Babies/Toddlers (0 to 3 years old)UnknownGoodGuardsPlayfulBarksRoughBitesFriendlyJumpsNot GoodNervousMouthyScratchesAttacksGentleChasesFights withToleratesGrowlsSnapsKillsWhich Behavior Describes Your FT with Young Children (4- to 8-years-old) (copy)UnknownGoodGuardsPlayfulBarksRoughBitesFriendlyJumpsNot GoodNervousMouthyScratchesAttacksGentleChasesFights withToleratesGrowlsSnapsKillsWhich Behavior Describes Your FT with Older Children (over 8-years-old) (copy) (copy)UnknownGoodGuardsPlayfulBarksRoughBitesFriendlyJumpsNot GoodNervousMouthyScratchesAttacksGentleChasesFights withToleratesGrowlsSnapsKillsWhich Behavior Describes Your FT with DogsUnknownGoodGuardsPlayfulBarksRoughBitesFriendlyJumpsNot GoodNervousMouthyScratchesAttacksGentleChasesFights withToleratesGrowlsSnapsKillsWhich Behavior Describes Your FT with CatsUnknownGoodGuardsPlayfulBarksRoughBitesFriendlyJumpsNot GoodNervousMouthyScratchesAttacksGentleChasesFights withToleratesGrowlsSnapsKillsWhich Behavior Describes Your FT with Other AnimalsUnknownGoodGuardsPlayfulBarksRoughBitesFriendlyJumpsNot GoodNervousMouthyScratchesAttacksGentleChasesFights withToleratesGrowlsSnapsKillsIs the Dog Afraid of (check any that apply)ThunderLoud NoiseVacuumCarsUniformsMenWomenChildrenOtherIf the Dog is Afraid of Other, Please ListIs the Dog Destructive When Alone or Confined?YesNoIf the dog is destructive, please check behaviors displayedChewsScratchesSoilsBarks/WhinesDigsOtherWhat Other Behavior is Exhibited When the Dog is Alone?When does the Destructive Behavior Occur? (Check Any that Apply)Day/InsideDay/OutsideNight/InsideNight/OutsideAlwaysHow Long is the Dog Alone When the Destructive Behavior Occurs?Less than Two HoursTwo to Four HoursFour to Eight HoursOver Eight HoursWhy are you giving this dog up?Please list the qualities you like most about this dog.What type of household would be ideal for this dog?QuietFairly QuietBusyVery BusyWhen the dog is outside, it isFencedTiedKenneledLooseInside invisible fenceHow long is the dog routinely left alone? dog? the the Where is the dog kept when alone?Please list family members and their ages that dog has lived with.Please list animals the dog has lived with. Describe, briefly, how the dog behaves with these animals.Check any of the following behaviors that the dog exhibits.Escapes/jumps fencesDoor dashDumps trashDigsLikes to fetchJumps on peopleLikes bathsBarks at noisesChases cars/bikesBarks at doorbell/knocksWhat type of food does the dog eat?What time of day is the dog fed?How does the dog react to new people?How does the dog react to the veterinarian?How does the dog react to the groomer?How does the dog react to unfamiliar situations?How does the dog react to strange animals?Under what circumstances does the dog growl?Under what circumstances does the dog snap?Under what circumstances does the dog bark?Is the dog allowed on the furniture?YesNoWhat pieces of furniture?What are the dog’s favorite toys/games/tricks?What does the dog most like to do?What does the dog least like to do? Has the dog had obedience training?Yes, formal trainingYes, trained on ownNeeds work, refresherNo trainingCheck the commands that the dog knows.SitStayComeOffDownPawShakeNoOtherHow has the dog been corrected when it misbehaves? How does the dog react to corrections?Is the dog allowed to play rough with people? YesNoIf yes, please describe rough play.This dog can best be described as (check any that apply).FriendlyOne person dogShyAggressiveHyperNoisyProtectiveObedientActiveQuietOutgoingDestructiveAffectionateSmartDemands attentionPlayfulEasy-goingLoyalAre there any places on its body that the dog does not like to be touched? If yes, please describe.By typing your name in the field immediately below and submitting this form, you are officially indicating that you are the legal owner of the animal and that you intend to surrender the dog to the ATRA Rescue.By typing your name and submitting this form, you are officially indicating that you are the legal owner of the animal and that you intend to surrender the dog to the ATRA Rescue. *Date *Your address *Your City, State and Zip *Email *Single Line TextSubmit
