Dog Courtesy Listing Agreement & Questionnaire Please enable JavaScript in your browser to complete this form. - Step 1 of 2Form Dog's Name *Breed(s) *Color(s) *Age *Approx. Weight *Photo Please upload a photo of the dog. ACCEPTED FILE TYPES ARE: PDF, JPG, JPEG, PNG, GIF File Upload Click or drag a file to this area to upload. Gender *MaleFemaleSpayed/Neutered *YesNoVaccines up-to-date? *YesNoDate of last Rabies vaccineMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date of last Distemper/Parvo combo vaccineMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is the dog licensed in Yavapai County? *YesNoIf “yes,” please provide the dog license tag number.Dog's personality (check all that apply)ShyOutgoingEasygoingPlayfulQuietFriendlyExcitableAffectionateMellowDominant*Needy*Fearful*If you choose Dominant, Needy, or Fearful above, please explainDog's behaviors (Check all that apply, give examples of circumstances)BarkyChewerJumps upDiggerEscapesNippyExamples of behaviors (be specific)Dog's energy level (check one) *HighMediumLowIs the dog comfortable with babies? *YesNoUnknownIs the dog comfortable with children? *YesNoUnknownIs the dog comfortable with men? *YesNoUnknownIs the dog comfortable with women? *YesNoUnknownIs the dog comfortable with cats? *YesNoUnknownIs the dog comfortable with male dogs? *YesNoUnknownIs the dog comfortable with female dogs? *YesNoUnknownIs the dog comfortable with small pets? *YesNoUnknownIs the dog comfortable with livestock? *YesNoUnknownIs the dog comfortable with horses? *YesNoUnknownDog’s Training (Check all that apply) *HousetrainedDoggy-Door-TrainedCrate-trainedGood on leashRides well in carWhere does your dog sleep? *Where does your dog spend his/her day (inside/outside)? *Do you crate your dog? *YesNoIf “yes,” when and for how long? (copy)How long have you had this dog? *How did you obtain this dog? *Brand of dog food usedAmount of foodHow often is your dog fed?Reason for re-homing (be specific) *List any special needs or concerns *Release of Veterinary Records My veterinarian/clinic is *Phone *I agree that UAF can obtain veterinary records regarding my dog, *I agree to phone my veterinary clinic to authorize the release of my dog’s veterinary records to UAF. Guardian Signature *Date *NextCourtesy Listing Agreement I understand that United Animal Friends (UAF) cannot take my dog into its foster system but will help me promote my pet to potential adopters. Showing my dog at adoption events greatly increases the chance of adoption, therefore I agree to attend events, a minimum, of 2 times per month. While showing my dog at an adoption event, I will hold UAF and the adoption site property owners harmless for any situation that might arise. I understand that my dog cannot attend events without the following documentation: Proof of spay/neuter Proof of Rabies vaccine for dogs older than six months of age While attending adoption events, I agree that: My dog is to be properly leashed (a 4-6’ leash – No retractable leashes and no choke/prong collars) and under the control of an adult at all times. I will not interfere with UAF adoptions. If my dog cannot be handled safely or if I am asked to leave for any reason, I will promptly andrespectfully leave the adoption event. I permit UAF to publish photos and descriptions of my pet on its website and other resources. UAF volunteers will verify adopter application information and collect a donation to UAF from the adopter. UAF will oversee as a private party adoption and will not be liable in any way for the success of the placement. I understand that if the adoption fails, the dog will be returned to me. I understand that re-homing can take a long time, so I will pursue other options if I cannot keep the dog beyond a specific date. I agree to notify UAF immediately if the dog becomes unavailable for adoption. It is UAF’s policy to remove a dog from the Courtesy Listing Program if there has been no interest in your dog from the public for 3 months. I understand that it is UAF’s policy not to adopt pets to those who have courtesy listed a pet. Acknowledgement and Agreement I understand and agree to the above terms. Guardian Signature *Date *Guardian Name(s) *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome PhoneCell Phone *Email *UAF Representative SignatureDatePreviousSubmit
