THE BARKING LOT RESCUESan Diego, CA

www.thebarkinglot.net·stacY@thebarkinglot.net . 858-405-6267

Your Barking Lot Pooch

Barking Lot Dog's Name: Home CheckBreed/Color: Date: I Time:Age: I Sex: Completed by:

Personal Information

Name: Age: I Date:SpouselPartner Name:

Or Roommate(s) Name(s):Street Address:

City: State: I Zip:Home Phone: Work Phone:Cell Phone: Email:

Occupation: Spouse's Occupation:

Work Schedule: Spouse's Hours:

Names of all persons living in your household:Their relationship to you & ages:Does EVERYONE in your family want to adopt this dog?

Name of personal reference:

Relationship: I Phone:

Your Home

Type of Dwelling: I Do you?: own rent

If you live in a Condo or Apartment, what are the association's rules about pets?

Your home has how many stories:

Does your home have a pool? I Is the pool fenced?How do you introduce the dog to the pool?

Would you object to an inspection of your home by a rescue volunteer?

Ifnot a home owner, do you have the landlord's permission to have a dog?Landlord's Name: I Phone:

Your pooch history

Do you presently have a dog?

Have you previous had a dog?

If you have/had dogs, please complete the charts below:

Current Pooch(es)Name: Breed: Age: Sex: Altered?Name: Breed: Age: Sex: Altered?How & Why Obtained:

How long have you had the dog(s)? IDog(s) kept InIOut:

Previous Pooch(es)Name: Breed: I Age: I Sex: I Altered?Kept InIOut: What Happened? *

Name: Breed: IAge: I Sex: IAltered?Kept InIOut: WbatlIappened?*

Name: Breed: I Age: I Sex: IAltered?Kept InIOut: VVhatlIappened?*

Name: Breed: I Age: I Sex: I Altered?Kept IniOut: What Happened? ** In the column, "what happened," write: gave away, sold him/her, took to the pound, died, etc. (If the dog died,please state cause of death.)

Have any of your dogs ever had puppies?If yes, you breed for: Fun Profit Show AccidentHas any member of your family ever experienced animal-related allergies?

Have you ever trained a dog in obedience classes?

Do you have other furry friends? Then please complete thefollowing:

Species: How many? IAges:Kept where? How long did you have your dog/cat?

If cat, de-clawed?

Your Family Veterinarian

IName: I Phone:

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Your New Pooch

Who would be responsible for the care ofthe dog?

What is your primary reason for adopting a dog?

Where would the dog sleep? I Inside (where?) I Outside (Where?)

How many hours per day would the dog be left alone?

Where would the dog be left when he/she is alone or when you are away from your home?

Is yard fenced? I Height: I Fence Type:Do you have a doggie door?Do you intend to hire a dog-sitter or take the dog to a daycare center?

When you are at home, where would the dog be?

If the dog will be outside at all, what outside space is available for the dog:

How do you plan to handle dog's exercise needs? (mark those that apply)Activity How often What duration each time

Walking 1-2/wk 3-5/wk Daily 2-3/day Rarely Never 15 min Y2hr Ihr >1 hrRunning 1-2/wk 3-5/wk Daily 2-3/day Rarely Never 15 min Yzhr Ihr >1 hr

Hiking 1-2/wk 3-5/wk Daily 2-3/day Rarely Never 15 min Yzhr Ihr >1 hrDog Park 1-2/wk 3-5/wk Daily 2-3/day Rarely Never 15 min Yzhr Ihr >1 hr

Beach 1-2/wk 3-5/wk Daily 2-3/day Rarely Never 15 min Yzhr 1 hr >1 hrYard Play 1-2/wk 3-5/wk Daily 2-3/day Rarely Never 15 min Yzhr 1hr >1 hr

Swimming 1-2/wk 3-5/wk Daily 2-3/day Rarely Never 15min Yzhr Ihr >1 hr

Do you feel obedience training makes a dog a better companion?

If necessary, would you be willing to attend obedience classes at your own expense?

Do you travel a great deal? I Howoften? I How long at a time?

When you do travel, how do you intend to provide for your dog(s) while you are gone?

Doggy Day Care I Kennel I In home pet sitting IDog(s) stay with friendsWhat provisions would be made for the dog if you had to move?Locally? lOut of state?To a place where no pets are allowed?

What would you do if your dog exhibited any of the following? (Mark all that apply)

Return to Give Seek professional Research to Increase OtherRescue Away training! behavior resolve issue exercise (please

consult on own explain)Chewing

Digging

Nipping

Barking

Shedding

TroubleHousetrainingDestructiveness

Marking

Disobedience

SeparationAnxiety

Aggressiontoward clOS7S

Growling at aperson

Jumping thefenceDo you have any "musts" for this dog to perform? If yes, please explain:

If the following circumstances occurred, what would you do with your pooch? (mark those that apply)

Return to rescue Take to the shelter Giveaway Keep Keep, but outside

Divorce

Newjob

Illness in family

Allergy

Moving

New baby

Kids ignore dog

UnexpectedMedical billsPets didn't getalong

Grew biggerthan expected

How much are you willing to spend on medical bills for your dog? (mark the one that applies)Up to $100 I Up to $500 Up to $1000 Up to $5000 Whatever it takesWhat would you do if the vet bills went over this amount?

The dog may live 15+ years. What would you do with your dog if you could no longer care for the dog?

Is there anything else you would like to tell us about yourself or your home environment?

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