Rehoming Your Dog - Weld Campus Name First Last PhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What brings you to NOCO Humane to surrender your dog?What breed is your dog?How old is your dog?How did you acquire your dog? (ex. Name of shelter/rescue)How long have you owned your dog?Who is your veterinarian?Does your dog have a microchip? If so, what is the microchip ID number?Is your dog's rabies vaccine up to date? When did your dog last receive the rabies vaccine?Does your dog have any known medical issues, dietary restrictions, or prescriptions?Has your dog been formally diagnosed with any anxiety conditions by a Veterinarian or Veterinary Behaviorist? If so, please list and explain.Has your dog ever displayed anxiety-related behaviors that have NOT been diagnosed by a Veterinarian or Veterinary behaviorist? Is so, please list and explain.Is your dog house trained?Is your dog crate trained?Please describe your dog's behavior while riding in the car:Please describe your dog's behavior while they are left alone:Is your dog leash trained?How is your dog off-leash? Are they "off-leash" trained?Does your dog know any commands? (verbal or body language)Has your dog received formal training? If so, what is the name of the trainer, and what training methods were used?Does your dog have any experience with sports? Such as agility, herding, dock diving, hunting, etc.Is your dog an indoor or outdoor pet?Does your yard have a fence? If so, what is the style of the fencing?Does your dog have a history of escaping?Please describe your dog's personality:What are your dog's favorite toys, games, and activities?Does your dog have any behaviors that you consider a problem?Does your dog guard their food, toys, people, etc? If yes, please describe the situations and behavior:Does your dog have any notable fears?What is your dog's behavior like while at the veterinarian?What is your dog's behavior when on leash and around other dogs?What is your dog's behavior when off leash and around other dogs?What is your dog's behavior when around children?What is your dog's behavior when around strangers?What is your dog's behavior toward cats?Does your dog have any aggressive behaviors? If so, please describe the situation(s) and behaviors:Has your dog ever bitten a person?Has your dog bitten and broken skin on a human in the last 10 days? Yes No If yes to the question above, please describe the situation:Who or what type of people have these behaviors occurred with? (ie. Children, men, women, strangers, bicyclists, veterinarians, owners, anyone at all, one person in particular)What behaviors has your dog displayed toward people? (Check all that apply) Growl Bark Lunge Hiss Swat Scratch Chase Urinate Snap Raised hair Tense Hard stare Fixate Has your dog ever been in an altercation with another animal? If yes, please explain:If yes to the question above, were there injuries from this altercation?If applicable, did the injured animal require medical treatment? What degree of damage was done? (ie. stitches, amputation, etc.)If applicable, how did you stop the altercation and how easily was the altercation stopped?What behaviors has your dog displayed toward people? (Check all that apply) Growl Bark Lunge Hiss Swat Scratch Chase Urinate Snap Raised hair Tense Hard stare Fixate Has your dog ever injured or killed another animal? If yes, please explain:Is there anything else you would like to share about your dog?Can we call you with follow up questions if needed?UntitledUntitledCAPTCHA
