LONE STAR Old English Sheepdog RESCUE

Date

Dog's name Age

Owner's Name:

Address

Home phone Work phone E-mail address:

Children how many? Ages

Other animals how many? Types

Where did you get this OES?

Name of breeder/pet store

Address & phone of breeder/pet store

How long have you owned the dog

Reason for giving up

Sex Spayed Neutered Altered Tail AKC records

Coat length (puppy cut, full length, shaved?) Last groomed? (date)

Groomer's name, address, phone

Does dog need to be groomed now? Matted? Bath?

How does dog react to being groomed?

Food type

Feeding schedule

Housebroken? If yes, how long can dog left?

What signal does dog give?

Is dog on lead or left alone for "potty?

Any information about the previous owner will be appreciated in the space below.

Previous owner's name

Address

Phone (home) (work)

Children how many ages

Other animals how many types

Reason for giving up

Veterinarian

Address

Telephone

Commands dog responds to:

Please indicate: (always - sometimes - never)

Sit: always - sometimes - never

Down: always - sometimes - never

Stay: always - sometimes - never

Come: always - sometimes - never

Heel: always - sometimes - never

Others:

Is dog leash trained? if yes (good-fair-bad)

Is your yard fenced? Is dog allowed to run loose? On leash at all times?

Can you take dog for a walk off leash?

Comments :

Health History

Do you have all medical records with you?

Your Veterinarian' name

Address,phone

Rabies vaccination Tag# date

Distemper vaccination date

Hepatitis vaccination date

Parainfluenza vaccination date

Parvovirus vaccination date

Leptospirosis vaccination date

Bordetella vaccination date

Corona vaccination date

Fecal date

Lyme disease vaccination date

Heartworm - date tested last given type used

Weight ; Height:

Please describe general health - including history of arthritis, colitis, skin problems,

allergies, etc. Also, urine & bowel control:

Typical day for the dog

Please list what the dog is doing and with whom during the day:

How many hours (maximum) can this OES stay alone?

How does dog behave when alone?

Is dog confined or allowed run of the house when alone?

When left alone inside, is dog:

Does your dog know how to swim?

Please check all that best describe the dog:

Aggressive

Confident

Dominant

Excitable

Hardheaded

Laid-back

Nervous

Responsive

Sedate

Shy

Stubborn

Submissive

Timid

Hyper

Puppyish

Cooperative

Characteristics and Peculiarities

The following is a list of dog behavior problems. Please list either (always - sometimes - never). If always or sometimes, please describe (when, where, why, etc.).

Barking excessively - under what conditions?

Begging

Biting - under what circumstances?

Growling When? Showing teeth When

Car behavior when riding

Car chasing

Car sickness

Cat chasing

Chewing – destructive

Digging

Dog fighting

Excessive wetting

Food guarding

Garbage ransacking

Grooming

Herding

Housebreaking "mistakes"

Jealousy

How is dog with children, and can dog be trusted with infants and small children?

Protective? Of whom?

How does dog react with strangers, other dogs and animals?

Jumping fences

Jumping on furniture Jumping on people Leash rejection Pulling on leash Mounting Nipping and mouthing Fear of confinement Fear of noises Fear of people Running away Stealing food Separation anxiety

Unique #1

Unique #2

How soon must you, or how desperate are you to give up the dog?

Would you be willing to keep the dog until it is placed?

Before this dog can be placed in a new home, he must be groomed, updated on inoculations. We also recommend that the dog be altered. If the owner is unable to do these things, we ask for a donation to help cover these expenses. We realize that every situation is different and our main concern is the welfare of the dog. Thank you for your cooperation.

I, (owner of said dog), have read, understood, and answered all of the above questions completely and honestly, making no misrepresentations concerning the temperament, health or behavior of the above named dog.

Printed Name: ____________________________________

Signed Date: _________________

Witnessed Date: _________________

(witness)_________________________________________

Send completed form to:

Jim McDaniel

3323 Cason,

Houston, TX 77005

Or e-mail as an attachment to: