First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Please be sure that you understand what a courtesy listing is. This application is for a courtesy listing for your dog. If your dog is courtesy listed on our adoption site, you will be required to continue to care for the dog while a new home is being sought. NASRN is a small, foster based organization. We do not have a kennel or shelter facility for you to surrender your dog. If a suitable adopter is found, the adoption agreement will be a private agreement between you and the adopting party.*
Choose one: I agree

PLEASE SEND AT LEAST 4 GOOD PICTURES. WEB BASED ADOPTIONS REQUIRE GOOD, CLEAR PICTURES OF THE DOG IN ORDER FOR POTENTIAL ADOPTERS TO CONNECT WITH THE DOG ONLINE. *NO HUMANS SHOULD BE IN THE PHOTOS *PLEASE SEND A MINIMUM OF 4 BUT NO MORE THAN 10.

Reason for rehoming your dog:*

Name of DOG (NOT YOUR NAME)*

What is the age of your dog?*

What breed is your dog? If it is mixed, include breed it is mixed with. *

Is your dog spayed or neutered?*

Is your dog current on vaccinations, including rabies? All dogs must have proof of rabies before being adopted.*

Is your dog current on heartworm preventative? *

Has your dog been given a heartworm test by a vet? If so, what was the result?

Does your dog have any health issues? *

What is your dog's approximate weight and height (measured from floor to top of shoulder.)*

Where did you acquire your dog? *
Choose one: Breeder Shelter Found

Name of breeder

If you acquired your dog from its breeder, have you contacted the breeder and asked for help?

If adopted, name of shelter or rescue group

How long have owned the dog? *

How old was the dog when you acquired it? *

Is your dog good with male dogs?*

Is your dog good with female dogs?*

Is your dog good with small dogs?*

Is your dog good with cats?*

Is your dog good with livestock?

If yes, what kind of livestock is your dog good with?

Is your dog good with chickens, ducks, geese?

Is your dog good with children under 5?*

Is your dog good with children over 5 years old?*

Is your dog good with men?*

Is your dog housebroken?*
Choose one: Yes No

Is your dog leash trained?*
Choose one: Yes No

Does your dog know basic commands such as sit, down, stay?*

Is your dog allowed on furniture?*

Is your dog Food aggressive? If yes, please explain.*

Does your dog Guards toys? From people? other dogs? If yes, please explain.*

Is your dog Destructive in the house? If yes, please explain.*

Does your dog jump fences? If yes, what height and type have they jumped?*

Does your dog climb fences? If so, what type and height?*

Does your dog dig under your fence to get out? If yes, please provide details.*

Does your dog bark excessively? If so, please provide details.*

Has your dog bitten a person? If yes, please provide details.*

Has your dog bitten or injured another animal? If yes, please provide details and type of animal involved.*

How does your dog react to visitors to your home? *

Please describe your dog's daily routine in detail. (feeding times, how many hours a day the dog spends alone, where is the dog kept while you are away during the day, where does the dog sleep at night, how much exercise is your dog used to...)*

In your words, please describe what you feel would be the best suited home for your dog *