UMDR Dog Rehoming Application

Pet Owner\'s Name *

Email Address*

Home Phone Number*

Other Phone Number

Address*

City*

Postal Code*

ABOUT YOUR PET

Pet\'s Name*

Breed/Breed Mix*

Colour/Markings*

Age of Pet*

Approximate Weight*

Hair Length*
ShortMediumLongHairless

Hair Shedding*
Light MediumHeavyNon-Shedding

Pet\'s Gender*
 Male Female

How long have you owned this pet?

Pet\'s Vaccinations are up-to-date?*
 Yes No

If not, will owner do? br />

Date of Last Rabies Vaccination*
 Yes No

My Pet is Spayed/Neutered?*
 Yes No

If not, will owner do?*
 Yes No

Medical history/Special needs/Problems?

Pet\'s Current Veterinary Clinic Name and Number

My Dog Is? (Check all that apply)*
 Friendly Sweet Mean Timid Dominant Aggressive Noisy Destructive Playful Demanding Quiet Other

If other, explain here

Cute habits my dog has*

Are there behavior issues that need work?*

Are there any on-going medical concerns with your pet?*

Is your dog house-trained?*
 Yes No In the process

Is your dog crate-trained?*
 Yes No

If yes, will you send the crate with your pet?*
 Yes No

My dog\'s obedience level is:*
 Needs Training Knows basic commands Has been to obedience school

Where does your dog normally sleep?

I feed my dog:*
 Dry food only Canned food only Dry and Canned Food My dog eats people food

At what time do you normally feed your dog?*

Where does your dog normally eat?*

What are some of your dog\'s favorite activities?*

How many hours of the day is your dog left alone?*

My dog lives with:*
children under 5children over 5No children

My dog is good with:*
Children under 5Children over 5Not good with young childrenGood with children any ageDon't know

f not good with children, give reason why:

My dog lives with other dogs:*
 Yes No

If yes, will your dog share his food bowl with other dogs?
 Yes No

Reaction to other dogs:*
GoodScaredFightsDon't know

My dog lives with cats:*
 Yes No

Reaction to cats:*
GoodChasesKillsDon't Know

My dog currently lives in:*
 House Apartment Other

If you checked other please specify:

My dog is exercised by:*
Running in the yardWalks on leashLeash Free ParksOther

My dog spends its time:*
Mostly IndoorIndoor OnlyOutdoor OnlyEqual time spent indoor and outdoor

Is your dog accustomed to:(check all that apply)*
BrushingBathingNail clippingGroomersAll of the aboveNone of the above

Does your dog have any particular fears such as vacuum cleaner? Please explain:*

Tell us three things you like about your dog:*

Tell us three things you would change about your dog:*

I would say my dog would be happiest in a home with:*
Adults onlyFamily with older childrenFamily any agesSingle personOther pets

I am surrendering my dog because:*

What advice would you give a potential adopting family about your dog?*

Placement Urgency:*
Urgent placement neededNo urgency but as soon as possibleI can keep my dog until a new home is found

By submitting this application I understand that I am agreeing to speak with an Ugly Mutts Associate with the intention of having my pet listed for adoption with their rescue organization.*
 Yes No

Please indicate the best time to contact you to discuss your pet\'s needs.*

I understand that an Ugly Mutts Associate will contact me to arrange placement of my pet but that Ugly Mutts does reserve the right to refuse any pet it deems unadoptable.*
 Yes No

We understand and empathize with any pet owner that finds themselves needing to find a new home for their pet and it is our goal is to alleviate the stress on your family and to ensure your pet continues to live a happy, healthy life.