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    E-mail Address: *
    Dogs Name *
    Dogs Age *
    Dogs Breed *
    Dogs Color *
    Dogs Sex *
    Spayed/Neutered? *
    Vet’s name and phone number? *
    Last Rabies Shot? *
    Last Vax? *
    Last Heartworm Test? *
    Heartworm positive or negative? *
    On Heartworm Preventative? *
    On Flea/Tick Preventative? *
    Date of last Grooming/Bath?
    How long has owner had dog? *
    Where was dog acquired (breeder, shelter, rescue, pet store, etc)? *
    Name of above (breeder, shelter, rescue, pet store, etc?) *
    Location of dog now (city/state)? *
    Reason for giving up? *
    Temperament? Specifically - how is dog with: women? men? children under 10? other dogs? cats? birds? *
    Has this dog ever bitten/nipped? *
    If so, what were the circumstances?
    Is the dog crate trained? *
    Is the dog housebroken? *
    Where has the dog been kept during the day (indoors/outdoors)? *
    Where has the dog been kept during the night (indoors/outdoors)? *
    Does the dog ride in a car? *
    (if yes, in what fashion: loose? crated? Seat belted?)
    How does the dog walk on a leash (trained to heel? pulls? etc)?
    Level of obedience? *
    Any current medical conditions? *
    Any other info? *
    Name of Legal Owner?
    Contact info for San Diego Spaniel Rescue (your name, phone, address, etc)? *
    Is a picture of the dog available?
    When was the photo taken?
    Upload a picture: (no larger than 2500 kb)
    * Required