Name:	Date:
Address:
City:	State:   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon   Zip:
Day Phone:	Evening Phone:
Email:

Do you have legal authority to relinquish ownership of this dog:     Yes   No If not please provide name, phone number and e-mail of anyone else who can claim ownership of this dog:

Owner name: Owner phone: Owner email:

Pet Information

Note that Hound Rescue can only assist with Beagles, Bassets, Coonhounds, Bloodhounds, Beagle Mixes and Other Hound Mixes, if they look mostly hound. For other breeds please check out petfinder.com to find rescues that might be able to assist.

What breed/mix is your hound:   Beagle Bassett Coonhound Bloodhound Beagle Mix Other hound mixes

AKC Registered Name:

Call Name:

AKC Registered Number:

Birthdate or approximate age:      Sex:     Female   Male

Dog was obtained from:     Friend   Pet Shop   Breeder   Shelter   Gift   Other If other, explain:

How long have you had this hound:

Why are you giving up your hound:

Medical Information

Veterinarian Name: Vet Address: Vet Phone:

Is your pet spayed or neutered:     Yes   No    If yes, date:

Is your hound on heartworm preventative:     Yes   No Treatment frequency:     Daily   Monthly   Other   Date last given:

Does your hound have any medical conditions that we should be aware of:

General Information

Is your hound a housepet:     Yes   No    Is your hound housebroken:     Yes   No

How frequently must he go out:

How does he tell you he needs to go out:

What food do you feed your hound:     Canned   Dry   Soft-moist Brand name:    Quantity:

Is your hound crate-trained (or has it been crate-trained even if it does not currently use its crate):     Yes   No

During the day, is your hound happiest in:     House   Crate   Outside    Other

At night, is your hound happiest in:     Bed with you   House   Crate   Outside    Other

How much time does your hound spend alone during the day:

How does your hound react when you leave the house:     Doesn't care   Whines/cries   Barks/howls   Destructive    Other

How do you exercise your hound:     Walk   Kennel Run   Yard   Run Loose

What games does your hound enjoy playing:     Frisbee   Fetch   Tag   Tug-o-War   Ball    Other

Does your hound know how to go up and down stairs:     Yes   No

Does your hound enjoy car rides:     Yes   No    Rambunctious   Rides loose quietly   Crated   Frightened   Car sick

Has your hound been raised with children:     Yes   No If yes, what ages:

Has your hound been raised with other animals,especially cats:     Yes   No If yes, what types:   How does your hound behave around other animals:

Pet Characteristics

Check all characteristics that apply to your hound: Active Affectionate Aggressive Attentive Confident Demanding Easygoing Fearful Happy Hardheaded Hyperactive Independent Insecure Loving Mannerly Obedient Passive Playful Quiet Reserved Sensitive Sociable Stubborn Submissive Timid Uncontrollable

What would you have liked to change about your hound: Aggressiveness Barking Biting Chasing Chewing Climbing Digging Fear of Noise Raiding the Garbage Growling Jumping up Soiling Overprotectiveness Running Away Fighting Stealing

Has your hound ever bitten or shown any aggressive tendencies:     Yes   No If yes, to whom, and under what circumstances (please be honest, you will be liable if this dog is placed and bites someone and you were aware that the dog had a history of biting)

Is your hound possessive of toys, food, or his people:     Yes   No How does your dog react if you approach his toys, food, etc.:

Discipline

Has your hound had obedience training, even a basic class:     Yes   No If yes, name and phone number of training school or instructor:

Instructor/School Name: Instructor Phone:

Who is primarily responsible for training and disciplining your hound:

How does your hound respond to commands:     Excellent   Good   Fair   Poor   When HE wants to

What is the best way to get your hound to listen/obey:     Praise   Treat   Correction   Firm voice   Other

What percentage of the time will he come to you when called:     100%   75%   50%   25%   1%

Does your hound walk on leash without pulling:     Yes   No

I accept the above terms:     Yes   No

We will need the following upon transfer of hound: a copy of hound's medical records, including spay/neuter certificate, Rabies certificate, and last DHLPP shot.