Dog Guardianship Form Pet Guardianship Dog Enrollment Form Thank you for taking the responsible step to enroll your beloved pet in Yavapai Humane Society’s Pet Guardianship Program. Dogs can’t talk, so they can’t tell us where or with whom they would like to live. To ensure that their home is a safe, happy & appropriate place for your dog to live, we need you to fill out this form in as much detail as possible. Detail & honest information from you is crucial to our placement process, so please take the time to fill in this profile with care & accuracy. Undesirable behaviors & medical issues do not necessarily create problems, however, not disclosing those problems definitely does. Inaccurate or incomplete responses can undermine the safety & happiness of both your dog & the new adopting family. If there are any questions that are unclear or that you are uncomfortable responding to for any reason, please ask to speak directly to one of our helpful staff about the issue.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Email *Address *Dog's Name *Dog's Age *Dog's GenderMaleFemaleDog's Breed *Dog's StatusSpayedNeuteredIntactHas dog been vaccinated within the past year?YesNoIf vaccinated, which veterinary facility?How long have you had the dog? *Less than 1 year1-3 years3 or more yearsWhere did you obtain this dog? *Yavapai Humane SocietyOther shelterBreederPet storeFriendFoundRescue groupNewspaperOtherTo your knowledge, how many homes has this dog had before living with you? *Please list the ages and sexes of the people this dog has lived withWould you recommend placing this dog in a home with children under 10 years of age? *YesNoNot surePlease explain your recommendation *If this dog lived with children under 8 years of age, how did they interact? *Actively avoided childGrowled at childChild could pet the dogIgnored each otherPlayed togetherGentle / AffectionateJump on / knock overUnknownCheck all that applyPlease tell us what other animals your dog has lived with *Male dog(s) un-neuteredFemale dog(s) un-spayedMale Dog(s) NeuteredFemale Dog(s) SpayedCat(s)Never lived with other animalsCheck all that applyWhat has been your dogs experience with other dogs in your home or outside of your home? *BulliesFrightenedFriendly / PlayfulNever around other dogsGrowls / SnapsShyCuriousJumps / Lunges on LeashIgnoresOtherCheck all that applyWould you recommend placing this dog in a home with other dogs? *How does you dog interact with cats? *ChasesCuriousFriendlyNever around catsBarks/lunges at catsIgnoresGentleUnknownHas injured/killedFrightened ofOtherCheck all that applyWould you recommend placing this dog in a home with cats? *How often does your dog go to the bathroom inside your home? *Every dayOnce a monthOnly when a puppyWhen yelled atIf left too longOnly when not homeMarks insideNever had inside accidentGoes while cratedOtherCheck all that applyIf your dog chews, what does he/she like to chew on? *Chews furnitureChews socks/clothingOnly chews toysDoesn't chew at allChews at fencesChews when not homeChews rawhide/bonesChews at doorways/windowsSteals items, then chews themOtherWhat does your dog do when you try to take an item away? *Where is your dog kept when you’re home? *Always outsideSometimes outsideCrate/KennelLoose in the houseIn garageConfined to a roomKept chained outsideIn basementOtherCheck all that applyHow many hours a day is your dog left alone? *More than 10 hours8-10 hours5-8 hours0-5 hoursNever left aloneOther - Please explain belowHow do you confine your dog to your yard? *None - dog runs freePartial fenceComplete fenceStockade/privacy fenceChained to dog house6 foot fence5 foot fence4 foot fenceOtherCheck all that applyHas your dog ever escaped? if so how? *Climbs the fenceRuns away if off leashDoes not escape or run awayOpens latchRuns but comes when calledDigs under/chews through fenceJumps over fenceOtherCheck all that applyWhat type of training has your dog had? *Group obedience classesProfessional/Private sessionsNever attended any obedience classesTrained at homeCheck all that applyWhat commands does your dog respond to? *FetchSitStayPaw/ShakeDownHeelOtherCheck all that applyMore dog training informationAre there any particular people or things that your dog appears to be afraid of? *MenDogsCars/TrucksStrangersLoud noisesChildrenWomenCatsWaterThunderstormsVacuums/BroomsPeople in uniformOtherWhat does your dog do that leads you to believe he/she is afraid?What circumstances or situations should be avoided that may cause your dog to growl or behave otherwise aggressively?Has your dog everBittenSnappedGrowledSnarledOtherCheck all that applyWas it at or overFoodRawhideToysStrangersChildrenAdultsOther AnimalsOtherCheck all that applyDoes your dog have any current, previous or recurring medical or behavioral problems?Is your dog currently on any medication? If so please list medications.How does your dog react while at the vets office?GrowlsCowers/FearfulTries to escapeHappy/PlayfulSnaps at vetNeeds muzzlePassive/doesn't careToleratesOtherCheck all that applyWhat part of your dogs body does he/she not like touched?FeetBackLegsHeadTailMouthBellyOtherCheck all that applyHow does he/she respond?SnapsGrowlsLungesUrinates/defecatesStruggles/attempts to escapeCowersOtherCheck all that applyWhat is the name of your veterinarian/veterinary clinic?What brand and type of food have you been feeding your dog?Digital Signature (type first and last name) *I certify that I have the authority to enroll the above described animal in the Pet Guardianship Program. Upon my death or incapacitation, I hereby relinquish all rights of ownership, in the above-described animal(s) in favor of Yavapai Humane Society, and I agree that the animal(s) may be placed up for adoption, transferred to another animal welfare organization or humanely euthanized at the sole discretion of Yavapai Humane Society. I authorize the transfer of my animal’s information (as listed above) to a new owner when this animal is placed up for adoption. The information on this form is to the best of my knowledge, accurate & complete. I understand that every effort will be made to place the animal in a foster home while it awaits adoption, but it may be housed temporarily in the YHS Adoption Center. I understand that YHS will attempt to place my animals in the same home but also understand the most important thing is to have them in a loving home, even if it means they are separated.Date *Submit
