My dog knows the following commands: (check all that apply)
Sit Lie Down Stay/Wait Heels on Leash Come
Most of the time, I would describe my dog as: (check all that apply)
Friendly Protective Affectionate Craves Attention Quiet Aggressive
Fearful Hyper Plays Rough Shy Playful Stubborn Destructive
My dog was last seen by a veterinarian on: ____________ at _____________________________
Vet Practice / Vet’s Name
My dog: Is Spayed or Neutered [If not, will you pay to have it spayed/neutered? Yes No
Is Microchipped, ID#__________________________________ Is Current on Vaccinations
Has Never Been to a Veterinarian
Other helpful information about my dog [health concerns, medications, behavior, etc.]:
[A behavior questionnaire is included on the next page]
Please review and sign below acknowledging the following:
I am the owner of this animal or the owner’s representative acting upon the owner’s consent.
Animals with illness or contagious disease, animals with age-related problems, and animals that pose a
health or safety risk to people or other animals and cannot be handled safely are not candidates for our
adoption program and may be humanely euthanized. Arkadelphia Animal Control cannot guarantee
adoption or placement of any animal. Sometimes health, age, or behavioral problems present after
admission, or our veterinarian/staff discover them upon examination or evaluation. Animals may also be
humanely euthanized if appropriate housing and care are not available.
I understand that whether or not this animal is made available for adoption is at the discretion of the
Arkadelphia Animal Control and that if I have questions regarding the disposition of this animal, I should
ask them now.
My signature below reflects that I read and understand the above information and that I am releasing all
rights and claims for this animal to the Arkadelphia Animal Control.