OUTREACH QUESTIONNAIRE

In order to process your relinquishment request, we must receive this completed form along with photos of the dog you wish to relinquish.  Photos must be sent as soon after submitting the form as possible.  All photos should be taken within five (5) feet of the dog at the dog's level.

Three poses will need to be taken...
1) full body shot of left side while standing
2) full body shot of right side while standing
3) front face shot.
If the tail is not visible in either of the side views, please include a picture of the dog from the back, so that the tail is in full view.

Upon submitting this form, please send your dogs photos to Intakes@SouthwestCairnRescue.com.  The sooner we receive your dogs photo's the faster we can help.
 

Date:

Dog's name:

Has the dog ever bitten anyone? Unknown No Yes    If yes, please explain

 

Owner Information

Your full name:

Address:

City, State, Zip:
   

Phone (H):

Phone(W or cell):

Email address:

How long have you had the dog?

Where was the dog purchased?

If from a breeder, please list name and phone number.

Name of your vet.

Vet Phone

Physical description of the dog.

Is the dog a purebred Cairn Terrier or mix? unknown purebred mix    If purebred, do you have any papers? unknown No Yes

Age:

 

Height:

 

Weight:

 

Color:

 

Sex: unknown male female

 

Is the dog spayed or neutered? unknown No Yes

 

Is the dog current on vaccinations including rabies? Unknown No Yes

 

Has the dog been tested for Heartworm? Unknown No Yes

 

If so, is it currently on heartworm prevention?  Unknown No Yes  

 

 

How does the dog react to:

 

unknown friendly shy growls aggressive      Other dogs

 

unknown friendly shy growls aggressive     Cats

 

unknown friendly shy growls aggressive      Strangers

 

unknown friendly shy growls aggressive      Men

 

unknown friendly shy growls aggressive      Women

 

unknown friendly shy growls aggressive      Children

 

unknown enters easily enters with help will not enter ok once inside      Crates

 

unknown enjoys fine once in the car gets sick barks at other cars      Car Rides

 

 

Unknown No Yes Does the dog pull when walked on a leash?

 

Unknown No Yes Is the dog afraid of storms?

 

Unknown No Yes Does the dog show any aggression if approached when he/she is eating?

 

Unknown No Yes Is the dog housebroken?

 

Unknown No Yes Does the dog come when you call it?

 

Please list any behaviors that your dog needs improvement ex. barking, jumping on people, runs away, fearful of mower/vacuum, etc.):

 

Why are you surrendering the dog?

YOU MUST AGREE TO OUR OUTREACH TERMS   AND THAT SOUTHWEST CAIRN RESCUE WILL PERFORM ALL COMMUNICATIONS BETWEEN OWNER AND ADOPTER AS WELL AS FACILITATE THE TRANSFER OF DOG TO THE NEW OWNER. PRIOR TO PRESSING THE "SUBMIT" BUTTON BELOW.  PLEASE CHECK HERE  THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO OUR OUTREACH TERMS, ARE THE LEGAL OWNER OF ABOVE DOG AND ARE AT LEAST 21 YEARS OF AGE.