Rescue Intake Form

Who We Are

The ISSDC is NOT A SHELTER. We rely on our network of breeders, members, and volunteers to help rescue, foster, and rehome Shiloh Shepherds. We are staffed entirely by volunteers with jobs, families, and their own pets.

Do you have a Dog in need?

In order to best serve those dogs in need and to assess whether or not we can help, the following form needs to be completed entirely.

Rescue Intake Form

OWNER/GUARDIAN INFO

Name (owner or current guardian)

First

Last

address

call name

Phone

registered name (if known)

date of birth

(if unknown, provide as much info as possible to assess age)

Phone (alt)

sex

males

female

spayed/neutered

yes

unknown

breed

shiloh shepherd

shiloh shepherd mix

unknown

current weight

DOG INFO

Is dog microchipped?

yes

unknown

If microchipped, please provide number.

(if no number, please respond "unknown" in this section)

Licensing

Is the dog currently licensed in its municipality of residence? If so, in what state? what county? when does it renew? (if unknown, write "unknown" in this spot)

Reason for rehoming.

Please explain the reason for rehoming this dog. Be as THOROUGH and HONEST as possible.

BREEDER

Breeder's name, if known

(if unknown, write "unknown" in this spot)

Have you reached out to the breeder regarding rehoming the dog?

yes

I don't know who that is

Brief summary of breeder outreach (check all that apply)

breeder unknown

breeder known, but unable to find contact info

breeder unwilling to take dog back

breeder unable to take dog back

breeder willing to assist club with placement

What was breeder's response?

If breeder was contacted, provide detail description of their response. (if breeder not contacted, write "no contact" in this section)

Veterinarian/Animal Hospital name

HEALTH

Veterinarian Address

Veterinarian Phone

VACCINES & PREVENTATIVES
Verification proof must be provided of all vaccines and tests.

Is dog up to date on all vaccines?

yes

unknown

Rabies: date of last vaccine

(if unknown, select today's date)

Distemper (DHLPPC): date of last vaccine

Protects your dog against distemper, hepatitis, leptospirosis, parainfluenza, parvo and corona; (if unknown, select today's date)

Bordatella: date of last vaccine

Protects against kennel cough; (if unknown, select today's date)

Canine Influenza: date of last vaccine

Canine flu shot; (if unknown, select today's date)

Heartworm (check all that apply)

negative

positive

unknown

is on preventative

Heartworm, date of last test

(if unknown, select today's date)

Heartworm Prevention

If on preventative, what brand? What was date last given? (if unknown, write "unknown" in this spot)

Fleas/Ticks

If on preventative, what brand? What was date last given? (if unknown, write "unknown" in this spot)

GENERAL HEALTH
Be as detailed as possible.

Supplements

List all supplements given. (if unknown, write "unknown" in this spot)

Medications (OTX & RX)

List all medications given (over the counter and prescription). (if unknown, write "unknown" in this spot)

Allergies

List all allergies (food, environmental, seasonal, etc). (if unknown, write "unknown" in this spot)

Diet

List current daily diet (brand of dog food, any toppings, etc) and number of times per day fed. (if unknown, write "unknown" in this spot)

Mobility

Describe any mobility problems dog is currently experiencing. (if unknown, write "unknown" in this spot)

General Health

Detailed description of anything not covered above. (if unknown, write "unknown" in this spot)

TEMPERAMENT

Activity Level (check all that apply)

Good with dogs?

Yes or No. Explain behavior regarding other dogs. (if unknown, write "unknown" in this spot)

Good with cat?

Yes or No. Explain behavior regarding cats. (if unknown, write "unknown" in this spot)

Good with children?

Yes or No. Explain behavior regarding children. (if unknown, write "unknown" in this spot)

Good with strangers?

Yes or No. Explain behavior regarding meeting strangers. (if unknown, write "unknown" in this spot)

Bite history.

Has this dog ever bitten or shown aggression toward adults, children or other animals? If yes please provide details of each incident. (if unknown, write "unknown" in this section)

Dislikes, Phobias, and/or Special Needs:

Explain. i.e. food aggression, nipping, separation anxiety, protective, escaping house/yard, chasing people or cars, bikes, etc. If yes please explain (if unknown, write "unknown" in this spot)

ADDITIONAL INFO

Additional Comments

Provide any additional information and/or comments you feel will help in placement of this dog. (if none, write "all done" in this spot)

Pictures:

We will need at least 2 clear photos of dog. A good clear face shot AND a full body picture of either sitting, standing, or laying down. Photos need to be no larger than 4mb in size and only png or jpg (jpeg) are accepted. Email us directly at rescue@issdc.com with photos. Include dog's name and rescue in the subject line. Intake Form will not be accepted without photos.

ACKNOWLEDGEMENTS, By submitting this electronic form, I certify ...

that I understand that ISSDC is a non-profit rescue that is staffed by volunteers.

that I have read the above information carefully and filled out this application honestly with factual and accurate information..

that I understand that inaccurate statements can result in the inappropriate placement which could end in very unnecessary stress on the dog, its new family, as well as the public.

that I understand euthanasia could be possible if temperament is found to be unstable and dangerous to new family and/or the public.

that I understand that all the above information will be verified.

that I am providing consent to contact Veterinarian for further information on this dog, if needed

that by submitting this form provides a signature

check all prior to submitting

If you are human, leave this field blank.