Cascade Beagle Rescue

Cascade Beagle Rescue

INTAKE INFORMATION
OWNER INFORMATION
Owner's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
DOG INFORMATION
Dog's Name

First DogSecond Dog (if applicable)
Breed
Gender

MaleFemale
Is this dog spayed/neutered?

YesNoUnknown
Dog's current age
How long have you had this dog?
Describe in detail the reason for surrendering this dog
Dog's beharior traits (check all that apply)

Barks excessivelyBiteMouthy/NipsJumps/climbs/digs under fencesEscape artistRides well in carHousebrokenPlayfulObedientSmartSweet, gentleDestroys propertySeparation anxietyAggressive towards other dogsAggressive towards cats/other animalsAggressive towards people/childrenGood with other dogsGood with catsGood with children 2 and underGood with older children
Describe any health issues this dog has
Date of last rabies vaccine

MonthDayYear
Date of last DHPP Vaccine

MonthDayYear
Microchip Brand (i.e. Avid, Home Again, etc)
Microchip Number
Your Veterinarian's name and phone
Do you understand that by completing this form, it does not mean CBR will take your dog?

YESNO - No need to continue if you checked this box
Should be Empty: