PASS Dog Re-home Form
Questions marked by * are required.
1. Today's Date: *
2. Your Name: *
3. Your Email Address: *
4. Your Telephone Numbers (cell & home): *
5. Your mailing address: *
6. How did you acquire this dog? *
  • I am the owner
  • I found this dog
  • I adopted this dog from a shelter/rescue
  • I acquired this dog from another owner
7. If you adopted your dog from another rescue group, have you contacted them about returning your dog? *
  • Yes
  • No
  • Does Not Apply
8. If you found this dog, have you tried to find the owner? *
  • Yes
  • No
  • Does Not Apply
9. Please explain everything you've done try to locate the owner? *
10. What is the dog's name: *
11. 13. How long have you had this dog? *
12. What is the dog's breed or breed mix (best guess): *
13. What is the age and weight of dog: *
14. What is the gender of dog: *
  • Male
  • Female
15. What is the reason you need to rehome this dog? *
16. Is there something we can help you with so you can keep your dog? *
  • Yes
  • No
17. If yes, please explain: *
18. What sort of people is this dog good with? Check all that apply. *
  • men
  • women
  • older children
  • young children
  • babies
  • senior citizens
19. Describe the dog's behavior around young children? *
  • Friendly
  • Snappy
  • Playful
  • Tolerant
  • Afraid
  • Aggressive
  • Unknown
20. How would you describe your household? *
  • Quiet
  • Average
  • Active
  • Noisy
21. What type of training does the dog have? *
  • obedience, basic - sit, stay, down
  • obedience, advanced
  • working dog training
  • service dog training
  • agility training
  • leash trained
  • crate trained
  • housebroken
22. How many hours a day is the dog left alone? *
  • 1-3
  • 3-5
  • 5-8
  • 8+
23. Where do you leave the dog when you're away? *
  • Crate
  • Kitchen
  • Bathroom
  • Run of the house
  • Outside with no access to the house
  • Outside with doggie door access to the house
24. How does the dog respond to being left alone? *
  • No problem
  • Barked
  • Digged
  • Chewed
  • Soiled house
  • Ran away
25. Where is the dog kept at night? *
  • Free run of the house
  • Crate
  • Bedroom
  • Owner's bed
  • Outside
  • kitchen
  • bathroom
  • screen porch
  • garage
26. During the day, how much time does the dog spend outside unsupervised?? *
  • under 1 hour
  • 1-4 hours
  • 5-10 hours
  • Over 10 hours
27. Is your yard fenced? *
  • Yes
  • No
28. What is the height of your fence? *
  • no fence
  • 3-6 feet
  • 6-9 feet
  • over 9 feet
29. What is your fence constructed of? *
  • No fence
  • Wood
  • Chain Link
  • Cinder block
  • Chicken Wire
  • Other
30. If your yard isn't fenced, how do you keep the dog confined to your property? *
  • Tie out
  • Dog run
  • Invisible fence
  • Walked on leash only
  • Runs loose
  • Does Not Apply
31. Does the dog chase anything? *
  • Does Not Chase
  • People
  • Cars
  • Children
  • Cats
  • Other dogs
  • Bicycles
  • Wildlife
  • Unknown
32. If the dog chases, please explain. If not, enter *
33. Is the dog frightened of anything? *
  • Men
  • Women
  • Children
  • Hands
  • Brooms
  • Vacuum cleaners
  • Water
  • Thunder
  • Fireworks
  • other dogs
  • cats
  • Unknown
34. What type of animals does the dog get along with? *
  • All dogs
  • female dogs
  • male dogs
  • large dogs
  • small dogs
  • Cats
  • Exotics
  • Wildlife
  • Unknown
35. Has the dog ever bitten a person or another animal? *
  • Yes
  • No
  • Unknown (found or rescued)
36. Please explain the circumstances in which the dog bit. *
37. Under what circumstances is the dog aggressive? *
  • Never
  • with strangers
  • when in pain
  • when afraid
  • when punished
  • when restrained
  • protecting food or toy
  • around other animals
  • unknown
38. Describe the aggressive behavior. *
  • Growls
  • Snarls
  • Lunges
  • Snaps
  • Bites
  • Unknown
  • Does not apply
39. Please give an example of a time when the dog was aggressive: *
40. Has the dog ever been cited by Animal Control? *
  • Yes
  • No
  • Unknown
41. If yes, please explain in detail the reason. *
42. What kind of dog food does the dog eat? How much and how often? *
43. Is this dog spayed or neutered? *
  • Yes
  • No
  • Unknown
44. If this dog is not spayed or neutered, do you agree to have that done at your expense before she/he goes to a new home? *
  • Yes
  • No
  • Does Not Apply
45. Is the dog up-to-date with vaccinations? *
  • Yes
  • No
  • Unknown
46. If yes, please provide date of last vaccinations. *
47. If the dog is not up-to-date with vaccinations, do you agree to have that done at your expense before she/he goes to a new home? *
  • Yes
  • No
  • Does Not Apply
48. What is the dog's heartworm status and has the dog been on monthly heartworm prevention? *
  • HW negative
  • HW positive
  • Unknown
  • Is on monthly preventatives
49. When did the dog last have the bordatella (kennel cough) vaccine? *
50. Is your dog microchipped? *
  • Yes
  • No
51. If your dog is microchipped, please provide name & phone number of microchip company and the microchip number. If not microchipped, enter Does Not Apply. *
52. Does the dog have any medical problems? *
  • Yes
  • No
  • Unknown
53. If this dog has medical problems, please explain in detail, including any medications needed. *
54. Please provide your vet's name, phone number, address: *
55. Do you agree to allow us to contact your vet as a reference? *
  • Yes
  • No
  • I found this dog but I don't have pets so have no vet
56. How long are you able to foster this dog? *
57. While fostering this dog, will you be able to transport to our vet, if needed, for exam, vaccinations and/or spay or neuter? *
  • Yes
  • No
58. In the own words, please describe your dog's personality and temperament. *
59. Can you email (pass@caabr.org) 3 to 6 good quality pictures of this dog in jpeg format? Before sending the pictures, ask yourself if the pictures you send would appeal to you if you were interested in adopting. *
  • Yes
  • No
60. How did you hear about Positive Alternatives to Shelter Surrender? *
  • Called CAA & they referred me
  • Went to CAA & they referred me
  • Friends of the Animals
  • PASS Facebook page
  • other
61. If you answered other, please tell us how you learned about PASS. *
62. I am enrolling this dog in the Friends of the Animals PASS Program for the purpose of rehoming. If we incur any expenses to get this dog adoption ready, I understand this dog must be rehomed through us where an adoption fee is required. If I rehome this dog myself after we have incurred expenses, I understand the adopter must pay an adoption fee to Friends of the Animals PASS Program OR I will be required to reimburse Friends of the Animals PASS Program for the expenses we have incurred. *
  • I agree
  • I disagree
63. I understand I am free to rehome my dog myself and no adoption fee will be required where PASS has incurred no expenses in getting my dog adoption ready. *
  • Yes
  • No
64. I agree to all terms and conditions included in this PASS intake form. *
  • I agree
  • I disagree