Owner Surrenders and Intake

Intake Form
It is important that if you are giving up your dog that you give us at least several months to try and find a foster placement or permanent home for them. We ARE NOT A TURN-IN SHELTER. We take in Owner Surrenders as a Courtesy. We do not have a shelter and are foster home run, so therefore we have VERY LIMITED SPACE and cannot be expected to take in your dog with one to two days or even a couple of weeks notice. New Hope Cattle Dogs will not take in any dog (s) that has a bite record or has aggression towards people and/or other dogs. Please take into consideration that we are a foster home run organization and all of our dogs live in homes with other dogs, sometimes cats and kids. It is MANDATORY that they are good with other dogs! A minimum donation of $50.00 is required upon surrender of your dog. This fee will help cover medical needs, housing and feeding of the dog.
Full Name *
Email Address *
Street Address *
City *
State *
Zipcode *
Phone Number *
Alternate Phone Number
Major Cross Streets *
What is the Dog's Name? *
Please list the primary breed of the dog *
If this dog is a mix, please list the secondary breed here
Please tell us the dog's date of birth, if unknown, please list approximate age: *
Did you find this dog as a stray or was he/she dumped on or near your property? *	Yes No
Is this dog spayed or neutered? *	Yes No Unknown
If not, please tell us why? (Ignore if dog is a stray)
Is this dog current on all shots (Distemper/Parvo, Rabies & Bordatella)? *	Yes No Unknown
If not, please tell us why? (Ignore if dog is a stray)
Please tell us why you are turning this dog in (please be specific): *
Please tell us where this dog primarily is kept *	Inside Only-free run of the house Inside/outside with dog door Outside only Crate Outside Kennel/Run Outside Cable/Chain/Tie out Laundry Room or other small room Garage, Barn or Workshop- no access to living areas
Is this dog housebroken? *	Yes No Unknown
Can/does the dog jump or climb fences? *	Yes No Unknown
Can this dog be trusted by itself inside for extended periods of time? *	Yes No Unknown
Can this dog be trusted by itself within a fenced yard? *	Yes No Unknown
Is this dog crate/kennel trained? *	Yes No Unknown
What kind (brand) of dog food do you feed this dog? *
Will you be able to provide at least a weeks worth of dog food to transition dog at time of intake? *	Yes No Maybe
Does this dog have any known medical issues? *	Yes No Unknown
If yes, please describe medical issue and indicate the medications he/she takes:
This dog is good with (please check all applicable): *	female dogs male dogs cats small animals horses cattle livestock (sheep, goats, donkeys, pigs, etc.) chickens or other birds All adults Men only Women Only Children under 5 yrs old Children 5-10 yrs old Children 10 & up
This dog is NOT good wit h (please check all applicable): *	female dogs male dogs cats small animals horses cattle livestock (sheep, goats, donkeys, pigs, etc.) chickens or other birds All adults Men only Women Only Children under 5 yrs old Children 5-10 yrs old Children 10 & up
Please check all the words/phrases that best describe your dog: *	Bites Kids Bites Adults Bites Strangers Nips or Heels/Hands/Legs/Clothes Mouths Hand (softly) Digs Barks to alert Barks incessantly Jumps on people Destructive Separation Anxiety Growls at people Growls at animals Chases Bikes Chases Cars Chases anything that moves Protective of Food Protective of Toys Protective of Owner Protective of Children Protective of House/Territory Territorial Happy Affectionate Aloof Friendly with Strangers Obedient Dominant Submissive Hyperactive Quiet Low Energy High Energy Gentle Playful Intense Focused Demanding Insecure Stubborn Sits for Treats Heels on a leash Bored Out-of-control Food Motivated Toy Motivated High Prey Drive Ecollar Trained Ball Crazy Fly Ball Dog Agility Dog Therapy Dog Service Dog Aggressive to Male Dogs Aggressive to Female Dogs Aggressive to Men Aggressive to Women Aggressive to Children Does not walk on leash Terrified of new things Fearful of Dogs Fearful of Men Fearful of Women Fearful of Children Fearful of Cars Herds Children Has Killed Livestock Small Animal Aggressive Has Killed Small Animals (including cats) Herds/Nips/Bites Horses
Has this dog ever bitten a person? *	Yes No Unknown
If yes, was this reported to the authorities or county pound?	Yes No Unknown
If you answered yes to biting, please describe the circumstances (be specific):
Has this dog ever attacked another animal? *	Yes No Unknown
If you answered yes, please describe the circumstances:
Where did you get the dog from? *	Friend Neighbor Pet Store Breeder Pound Shelter Rescue Group Found as a Stray
Has the dog been obedience trained by a professional obedience trainer? *	Yes No Unknown
If you answered yes to the above question, who was the tainer (please list name and city/state)?
Does the dog have a current Veterinary? *	Yes No Unknown
If yes, Please give us the Veterinarian's name and address.
Do you agree to provide us with all the information (including vet records) we need to place your dog? *	Yes No
Do you agree to foster the dog until we can find it a new home? *	Yes No
Do you agree to our intake policies and procedures? *	Yes No
Do you agree that you have answered all the above questions truthfully and to the best of your knowledge? *	Yes No
Additional Comments:
Please submit a photo of the dog you are submitting here:
Additional Photo:
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Full Name *
Email Address *
Street Address *
City *
State *
Zipcode *
Phone Number *
Alternate Phone Number
Major Cross Streets *
How many dogs are you wanting to surrender? *
What is the Dog's Name? *
Please list the primary breed of the dog *
If this dog is a mix, please list the secondary breed here
Please tell us the dog's date of birth, if unknown, please list approximate age: *
Did you find this dog as a stray or was he/she dumped on or near your property? *
Is this dog spayed or neutered? *
If not, please tell us why? (Ignore if dog is a stray)
Is this dog current on all shots (Distemper/Parvo, Rabies & Bordatella)? *
If not, please tell us why? (Ignore if dog is a stray)
Please tell us why you are turning this dog in (please be specific): *
Please tell us where this dog primarily is kept *
Is this dog housebroken? *
Can/does the dog jump or climb fences? *
Can this dog be trusted by itself inside for extended periods of time? *
Can this dog be trusted by itself within a fenced yard? *
Is this dog crate/kennel trained? *
What kind (brand) of dog food do you feed this dog? *
Will you be able to provide at least a weeks worth of dog food to transition dog at time of intake? *
Does this dog have any known medical issues? *
If yes, please describe medical issue and indicate the medications he/she takes:
This dog is good with (please check all applicable): *
This dog is NOT good wit h (please check all applicable): *
Please check all the words/phrases that best describe your dog: *
Has this dog ever bitten a person? *
If yes, was this reported to the authorities or county pound?
If you answered yes to biting, please describe the circumstances (be specific):
Has this dog ever attacked another animal? *
If you answered yes, please describe the circumstances:
Where did you get the dog from? *
Has the dog been obedience trained by a professional obedience trainer? *
If you answered yes to the above question, who was the tainer (please list name and city/state)?
Does the dog have a current Veterinary? *
If yes, Please give us the Veterinarian's name and address.
Do you agree to provide us with all the information (including vet records) we need to place your dog? *
Do you agree to foster the dog until we can find it a new home? *
Do you agree to our intake policies and procedures? *
Do you agree that you have answered all the above questions truthfully and to the best of your knowledge? *
Additional Comments:
Please submit a photo of the dog you are submitting here:
Additional Photo:


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