Chesapeake Bay Retriever Relief & Rescue

Date: __________________________

Shelter Dog Evaluation

Dog's Name: __________________________ Age: ________________ Sex: _______________
Size: ___________________ Color: _____________________ Dog neutered/spayed? _________

Shelter Name: ___________________________________________________________
Phone: ________________________________
Address: _______________________________________________________________

Where and at what age did owner obtain dog? _________________________________________
Breeder called? ________________
Shots Up to Date? ___________________ Heartworm Preventative? _______________
Medical Problems? ______________________________________________________________
Where was dog kept days? ________________________________________________________
nights? ________________________________________________________________________
Housebroken? ____________ Crate Trained? ____________________
Regular contact with children? ________________ Ages: __________________________________

Briefly describe the dog's physical condition: _____________________________________________
Are there any signs of bites or unexplained open lesions on the dog's body that could be the result of a fight with  a wild animal? ____________ If there are, we cannot take the dog. If there are bites and the dog does not have a current rabies tag/vaccine record, the dog must be reported to the local ACO/vet for quarantine.

When the shelter person brings out dog, observe how the dog reacts to his surroundings and to you. Before you speak or try to get dog's attention, see if dog approaches you, or checks out the surroundings first: _________________
Does he jump up? ___________ Try to run away? _____________ Check out everything but you?______
Other? ____________________________________________________________________________
Call the dog, being careful. Does dog: "love" you_____ tolerate you____ retreat____ show disinterest_____
Approach the dog, being careful. Does dog: "love" you____ tolerate you___ retreat___ show disinterest____
Offer him a tidbit on the ground/floor. Does dog: take it____ reject it____
Offer him a tidbit from your hand. Does dog: take it____ reject it____
Offer your hand to stroke him, but NOT on the top of dog's head. Is there a friendly response or fear?
Dog's reaction to family and strangers, if known: _______________________________________________
List commands dog demonstrates (can use food): ______________________________________________
What type of collar does/did dog normally wear? buckle___ choke___ pinch___ head halter___

Walk with dog on leash. Is there trust or fear?___________________ Separation anxiety?_______________
Does the dog pull on leash? Yes___ No___
Describe his behavior on leash: ____________________________________________________________
Do we know if dog has food anxiety or toy possession? __________ You can try this, carefully, by putting some food in the dogs dish, letting him have some, and then approaching him slowly. Do NOT put yourself in danger of being bitten - WATCH the dog's reactions! _______________________________________________________________
Will the dog play fetch with you? ________ How excited is s/he for a toy? _____________________________
Does he bring the toy to you? Yes___ No___ Will he release a toy to you? ____________________________

Reaction to sudden loud noises and/or household noises (drop a few empty soda cans near the dog, but not right next to him): _________________________________________________________________________________
Reactions to male dogs. Does dog show: interest___ tolerance___ play___ fear___ aggression___
Reactions to female dogs: Does dog show: interest___ tolerance___ play___ fear___ aggression___
Reaction to hand suddenly lifter (Stand AWAY from dog with somebody else holding leash securely, but leash is loose - be VERY CAREFUL): ______________________________________________________________________
Reaction to rolled newspaper suddenly lifted (Stand AWAY from dog with somebody else holding leash securely, but leash is loose - be VERY CAREFUL): ____________________________________________________________

Can you touch the dog's muzzle? Yes___ No___ Paws? Yes___ No___
Touch dog's body elsewhere? Yes___ No___

Give the dog a once-over from a health perspective - teeth OK, no open wounds (that can't be explained), no lameness, fur OK everywhere, no swellings anywhere, ears OK? _______________________________________________
Check for ticks/fleas: ______________________________________________________________________

Ask about dog's car behavior: _______________________________________________________________
Activity level: ____________________________________________________________________________
Frequency and how exercised: _______________________________________________________________
Nerve (from what you can see): very shy___ reserved___ normal___ confident___ other____________________
What brand of food did the dog eat at home? ____________________________________________________
Now? _________________________________________________________________________________
Does the dog submissively urinate? ____________________________________________________________
Briefly describe personality: _________________________________________________________________
Has dog changed while in the shelter, personality-wise? _____________________________________________
Aggressive with people at all? ________________________________________________________________
Owner's reason for placement: _______________________________________________________________
Do you feel that this dog is placeable? ___________ Why or why not? _________________________________

Evaluator's name and phone number: ___________________________________________________________
Best time to call you about this dog: ____________________________________________________________
How long can this dog stay at this facility? ________________________________________________________
Is transportation needed for this dog to intake facility (if we are taking him)? ______________________________

Please return this form to:

Chesapeake Bay Retriever Relief & Rescue
82 Pinewood Ave.
Albany, NY 12208

(To be filled out by adoption coordinator)
Intake Location: __________________________________________________________________________
Approximate Arrival Date: ______________________________ Actual Arrival Date: _____________________