Iowa Golden Retriever Rescue, Inc

Iowa Golden Retriever Rescue, Inc.

= 108 Grand Ave

West Des Moines, IA 50265-3710

515-255-1884

Released Dog Information Form

Name &n= bsp; = ; &n= bsp; = ; &n= bsp; Street Address &nb= sp; = &nb= sp; =

Phone &= nbsp; &nbs= p; &= nbsp; &nbs= p; C= ity &nbs= p; &= nbsp; State &nbs= p; Zip = ;

Referred By = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp;

Name of Dog &= nbsp; &nbs= p; &= nbsp; &nbs= p; Sex = ; Spayed/Neutered? Y N

Date of Birth &n= bsp; = ; &n= bsp; Weight = Color &nb= sp; =

Markings/Tattoo/Microchip = &nb= sp; = &nb= sp; IGRR I.D.: = &nb= sp;

Shots up to date? = Last vaccination date &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Vet’s Name and Phone Number &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

How long have you owned the dog? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Reason for surrender = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp;

= ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ;

Food type/brand = &nb= sp; = Amount & times per day &= nbsp; &nbs= p;

Where is your dog during the day? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Where is your dog at night? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

How much and what kind of exercise does your dog need each day? &= nbsp; &nbs= p; =

= &nb= sp; = &nb= sp; = &nb= sp; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Any health problems? List all &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

= ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ;

<= /p>

Does your dog get ear infections? &= nbsp; Skin problems or hot spots? = ; &n= bsp; = ;

Other = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; =

Where did you get the dog?

Breeder?** (breeder’s name) = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; ______

Pet Store? (store name) &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

Other? (= please explain) &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; =

**If you purchased the dog from a breeder, was t= here a return clause in the purchase agreement?= Yes No

If yes, have you contacted the breeder? Yes No

Please answer yes or no to the following questio= ns. If applicable, please explain.

Is / Has or Does this= dog:

<= /p>

Housetrained _ = Had obedience training? _______________________________________________

Object to being groomed? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; __________________ &= nbsp;

Ever bitten/attempted to bite anyon= e? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; ______ &= nbsp; &nbs= p;

_______Ever growled/shown teeth at anyone? ______________________________________________________

Act fearful? When/why = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp;

Destructive when left alone? = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp;

Guard food or toys? = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &= nbsp; Good with children? If yes, ages? I= f no, explain. &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; ____________________________________ &= nbsp;

Pull on leash? = &nb= sp; = &nb= sp; = &nb= sp; ____= ___ &= nbsp;

Respond to name? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

Get along with male dogs? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Get along with female dogs? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Get along with cats? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

Bark a lot? = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ;

Like to ride in= cars? &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Like to swim? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; ______ &= nbsp;

Playful?= = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; =

Get into garbage/onto counter? <= span style=3D'mso-tab-count:7'> &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

Sleep on furniture/bed? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Chew on wrong items? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Jump fences? How high? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Dig? &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Run away? = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ;

Chase cars/motorcycles/bikes? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

______ What does your= dog dislike/fear? How do they react? &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; <= /span>

Is your dog accustomed to be= ing: &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

Tied up? = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ;

In a fenced yar= d? &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

In a dog pen? = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; =

Invisible fence= ? &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Crated/caged? = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp; =

Loose? = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; = ;

Leash walked? = &nb= sp; = &nb= sp; = &nb= sp; = &nb= sp;

Left alone for long periods of time= ? (how long) &nb= sp; = &nb= sp; = &nb= sp; =

Please provide any additional information you fe= el is important.

IGRR Use only:

&nb= sp; = Vet appointment: &nb= sp; = &nb= sp; = &= nbsp; IGRR #: &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

&nb= sp; = Transport: &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; Foster: &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

&nb= sp; = Date: &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; IGRR Rep: = ; &n= bsp; = ; &n= bsp; = ;

Additional Notes: