Completing this form does NOT guarantee we will accept your dog into our program: Acceptance depends upon, but is not limited to, foster space available and our evaluation of the dog.
Owner's Name
(area-code) xxx-xxxx
Street Address
City State
Zip/Postal Code
Dog Information
Please provide as much detail as possible about the dog.
Dog's Name Date of Birth
Color Gender
  • Yes
  • No
If yes, date?
Does the dog enjoy ...
  • Walks
  • Riding in the car
  • Meeting strangers
  • Water (e.g., ponds, lakes)
  • Toys
  • Other
If "Other", please describe
Does dog get carsick?
  • Yes
  • No
Other comments?
Has the dog ever been ...
  • Kenneled
  • Chained
  • Allowed to run loose
  • Injured in any way
  • Abused by a person
  • Attacked by another animal
  • Neglected
  • Used for breeding
  • Left in a fenced yard
If left in fenced yard, what percent of day?
Other comments?
  • Friendly
  • Cautious
  • Anxious to please
  • Aggressive
  • Shy
  • Afraid of people
  • Reserved
  • Scared
  • Confident
  • Loves everyone
  • Protective
  • Obedient
  • Hyper
  • Trainable
  • Stays nearby if loose
  • Loves other dogs
  • Dominant
  • Submissive
Other comments?
Is/Has the dog ...
  • Good with children
  • Been around small children
  • Used to being around other dogs
  • Used to cats
Any dislikes?
Has this dog ever bitten ...
  • A person
  • An animal
If yes, date and details?
Action taken?
  • Crate trained
  • Barks
  • Finicky eater
  • Walks on leash
  • Digs
  • Escape artist
  • Fence jumper
  • Chews/destructive
Is dog housebroken?
  • Always
  • Sometimes
  • Never
What signals are given?
Any bad habits?
Commands or tricks the dog knows?
Formal training/titles?
Brand/Amount of food?
How often fed?
Medical History
Name of regular veterinarian
Vet's Phone
Vet's Clinic Name & Address
Date of last immunizations
Date of last heartworm test
Date of last heartworm preventative
Current medications
Flea treatment?
  • Yes
  • No
  • Yes
  • No
How did you hear about us?
(Using a web search engine? On another Rescue site? From a person?)
Protege Canine Rescue is a 501(c)(3) non-profit rescue service. Thanks for your interest in our volunteer organization.

I hereby affirm that all of the above information is true and correct. I understand that submission of this application does not necessarily mean that I will be approved to adopt and that you reserve the right to reject any applicant. I authorize you to verify any and all information set forth in this application and to contact my personal and veterinary references.

By submitting this application, I declare that all of the above information I have given is true and complete.

We cannot process your application unless you initial and date your application.

Please review your application to ensure it has been filled out completely, then press the Submit button below which will forward your application form to Protege Canine Rescue for processing. Incomplete forms will be rejected immediately. Please do not submit the form until you have completed it. Once you have successfully submitted the form, please do not submit it again.