First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Cell Phone

Dog's Name*

Dog's Age*

Dog's Birthday if Known:

Approximately how tall is your dog at the shoulder?*

Approximately how much does your dog weigh?*

Is your dog papered or registered?*

How did you acquire your Belgian Malinois?*

Do you know the breeder for your dog? If so, please provide name or Kennel name. *

Is your dog male or female?*

Is your dog spayed or neutered?*

Is your dog up to date on all vaccines including Distemper, Parvo, and Rabies? List any vaccinations received and date administered. *

Is your dog on Heartworm Preventative?*

Does your dog have a medical condition? If so, what condition do they have?*

Is your dog microchipped?*

If microchipped, please give the number if you have it:

Why are you surrendering your Malinois?*

Do you have a deadline for rehoming your dog?*

Will you be able to keep your dog while we try to find a new home for him/her?*

Has your dog bitten anyone in the past?*

Does your dog have a bite history with animal control?*

Is your dog reactive to other dogs?*

Is your dog reactive to cats?*

Is your dog reactive to children?*

Is your dog reactive to strangers?*

Is your dog reactive to thunderstorms?*

Is your dog reactive to loud noises?*

Is your dog reactive to riding in vehicles?*

Is your dog reactive to moving things such as traffic, cars, bicycles, runners, etc?*

Has your dog spent time with other dogs? How is their behavior with other dogs? Are they good around small dogs or do they prefer dogs their own size? Are they better with dogs their same sex or opposite sex? Please explain in detail.*

Has your dog spent time with cats? If so, how do they behave with cats?*

Has your dog spent time with children? If so, what are the children's ages and how did the dog behave?*

How does your dog do in public and with unknown people?*

How well does your dog ride in a car or truck? Are they typically riding free, tethered, or in a crate?*

What food is your dog currently eating?*

Have you had any issues with food and your dog? And if so, what were the issues. *

What are your dog's favorite treats?*

What are your dog's favorite toys?*

What type of ball drive does your dog have? Or how much does it like to play ball? Choose the most accurate description. *

What is the dog's food drive like?*

What is the dog's toy drive like?*

How is your dog with fences?*

Have you done any dog sports with your dog? If so, tell us what sports. *

What kind of activities do you do with your dog? Tell us about it.*

Has your dog had any type of bitework or protection training?*

Does your dog have any official training? At home/professional training? If so, tell us about it. *

What would be your dog's ideal home or future life?*

Where does your dog typically sleep?*

Is your dog crate trained?*

Is your dog housebroken? How does he indicate that he needs to go outside to potty?*

Has your dog shown any signs of separation anxiety? Please answer yes or no and if yes, explain what the dog does when alone. *

What are some cute or funny stories about your dog?

List all the commands your dog knows. *

What does your dog still need to work on?*

How does your dog do with vet visits, nail trims, baths, grooming, taking medications, touching paws?*

What on-going medical issues does your dog have?*

Will your dog be bringing any items with him/her? (such as: leash, collar, bed, toys, crate, food, medicines, etc)*