2. St. Joseph Animal Control and Rescue Dog Intake Form

4. If you have found a stray dog, do not complete this form.  You may call the shelter at 271-4877 and make an appointment to drop it off.

6. Owner Information

8. Name*
9. Address*
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Alternate Phone Number
18. Email Address*
20. If assistance is available to help keep your dog, would you be willing to discuss this with an Animal Resource Representative?​

    1. Yes
    2. No

22. Animal Information

24. Animal Name*
25. Breed*
27. Color*
28. Sex*
29. Age*
31. Why are you surrendering this dog? (check all that apply)*

    1. Moving
    2. Landlord does not allow pets
    3. Can no longer afford
    4. Owner's health
    5. Pet's health
    6. Unable to train
    7. Other
32. If other, please explain below
34. How long have you owned your dog?
36. Is your dog spayed or neutered?

    1. Yes
    2. No
38. What was the name of the clinic that performed the surgery?
40. Is your dog microchipped?

    1. Yes
    2. No
42. If yes, who is the microchip manufacturer?
44. Has your dog every bitten a person?*

    1. Yes
    2. No
46. If yes, please explain:
48. Where does your dog receive veterinary care?
49. What name are the vet records under?
51. Is your dog currently vaccinated for? (check all that apply)

    1. Rabies
    2. Combo Vaccine
    3. Kennel Cough
    4. Not current on vaccines
53. Please list any health issues your dog has:
55. Please list any medications or special diet that your dog is on:
57. What brand of dog food does your dog eat?
58. What type of food do you feed?

    1. Dry
    2. Canned
    3. Both
59. When do you feed your dog? (check all that apply)

    1. Morning
    2. Afternoon
    3. Evening
    4. Free Feed
61. Has your dog lived with or been around other dogs?

    1. Yes
    2. No
62. What size of dogs has your dog been around? (Check all that apply)

    1. Toy (under 20 lbs.)
    2. Small (up to 40 lbs.)
    3. Medium (up to 75 lbs.)
    4. Large (over 75 lbs.)
63. What was your dog’s reaction to them? (check all that apply)

    1. Playful
    2. Doesn't Mind
    3. Dominant
    4. Submissive
    5. Unpredictable
    6. Growls
    7. Barks
    8. Snaps
65. Comments
67. Has your dog lived with or been around cats?

    1. Yes
    2. No
68. What was your dog’s reaction to cats? (check all that apply)

    1. Playful
    2. Friendly
    3. Ignores
    4. Chases them
    5. Afraid of them
    6. Has attacked them
70. Comments
72. Has your dog been around other types of animals? (birds, reptiles, livestock, etc)

    1. Yes
    2. No
74. If yes, please list the kind of animals your dog was around:
76. What was their reaction?
78. Describe your home environment

    1. Active
    2. Average Activity
    3. Quiet
80. Has your dog been around children?

    1. Yes
    2. No
82. If yes, what were their ages?
84. How did the dog react?
86. How does your dog react to new people?
88. Where was the dog kept when nobody was home? (check all that apply)

    1. Free run in home
    2. Kennel/crate
    3. Outside
    4. Other
89. Is your dog comfortable being alone?

    1. Yes
    2. No
90. Is your dog destructive when left alone in the house?

    1. Yes
    2. No
92. If yes, how are they destructive?
94. How often was your dog kept outside?

    1. None
    2. Less than an hour
    3. 2-6 hours
    4. Lived outside
95. Is your dog housetrained?

    1. Yes
    2. No
96. Is your dog crate trained?

    1. Yes
    2. No
98. Is your dog possessive of? (check all that apply)

    1. Toys
    2. Food
    3. Owner
    4. Property
100. Does anything frighten your dog?

     1. Yes
     2. No
102. If yes, what frightens your dog?
104. Where does your dog sleep? (check all that apply)

     1. Crate/kennel
     2. Dog bed
     3. Your bed
     4. Floor
     5. Isolated Room
     6. Couch
     7. Outside
106. Please list any other information you would like to share with us about your dog:
Leave This Blank:


108. 1. Receive an email copy of this form.
109. Email address

     This field is not part of the form submission.

110. Submit

* indicates a required field