Yankee Chihuahua Rescue and Adoption, Inc (YCRAA)

Application for Yankee Chihuahua Rescue Intake

Only residents of Connecticut, Rhode Island, Maine, Massachusetts, New Hampshire, and Vermont can be considered.

We can not accept dogs outside of these areas. Contact Chihuahua Rescue and Transport (CRT) for information about surrendering your Chihuahua in your area.)

To have an Intake Application automatically emailed to you please send an email to:
Intake.application@YankeeChihuahuaRescue.org

If you can not complete the application or have questions then please email us: Intake@YankeeChihuahuaRescue.org

* Name

* Street Address, Town/City, State, Zip

* State

Please note: We can not accept dogs outside of these areas. Contact Chihuahua Rescue and Transport (CRT) for information about surrenders in your area.
Mailing Address if different from Home address


* Home phone 
   Cell phone    
   Work phone  

* Best time to call, and preferred phone

* Email (YCR preferred contact method)

* Dogs Name


DOGS HISTORY

* Where did the dog originally come from?

* Is the dog registered with the AKC or CKC? Are the registration papers/pedigree available?

* Who is surrendering or releasing the dog? (Owner/Relative of owner/ if shelter or rescue group, please name)

* Reason for surrender/release?

*


PHYSICAL DESCRIPTION

* Age, Sex, When Spayed/Neutered

*

* Color, Markings, Coat Type (short or long hair)

* Any permanent identification? (ID, tattoo, microchip, tag?)


* MEDICAL/HEALTH ISSUES

Date of last vaccinations?
Date of last veterinarian visit?
Reason for last veterinarian visit?

* List any current/past allergies, chronic illnesses, diseases, etc:

* Name and Phone Number of Dog's Veterinarian


BEHAVIOR

Please Note: We cannot/do not take in aggressive dogs or dogs that bite.
We are a volunteer group and do not have the training to provide behavior modification. Please contact a Certified Applied Animal Behaviorist.

* General description of behavior: (For example: Confident/shy? Friendly/reserved? Fearful? High/low activity level? Submissive? Aggressive? Quiet/noisy?)

* Is the dog house trained?
Comments

How does the dog typically respond to . . .

Strangers met on walks?
Strangers coming into the house?
Men vs. Women?
Children vs. Adults?
Other dogs in the house?
Other dogs met on walks?
Big dogs vs. small dogs?
Male vs. Female dogs?
Friends and family members?
Cats?
Other animals (specify)?
At the groomer's or boarding kennel?
At the Vets
When being groomed, nail trimming, bathing?
How does the dog respond to commands /Obedience?
What does the dog dislike or fear?
What does the dog especially like/enjoy?
Has the dog snapped at, nipped, or bitten people?
We cannot/do not take in aggressive dogs or dogs that bite.
Please contact a Certified Applied Animal Behaviorist.
Has the dog shown aggression toward people/children?
Has the dog shown aggression toward other animals?
If yes to either question above, please detail all circumstances of aggression.
Equipment, toys, other items to be sent with dog.

I represent that the information that I have provided on this form is the truth to the best of my knowledge and belief and hereby give my permission for you to use any of the above information to confirm that all information provided is the truth. This means you give us your permission to call references and that you allow us to contact your vet and that you hereby give consent for your vet to release the information in your current/past pet's health files to us.

* Signature 
This is an Electronic Signature
It represents your acknowledgement that everything above is true.

Where did you hear about us? Comments?

Submit Application:
To Reset the Application and start over

If you are not returned to a 'Thank-You' Page after submitting this form,
then your application did NOT go through.

We at Yankee Chihuahua Rescue display a Rescue Photo I.D. Badge while conducting rescues, home visits and/or general rescue business. We will provide, and leave a signed surrender form with you with the Volunteer's name.

Please don't surrender a dog to anyone unless the volunteer displays a badge with the YCR logo and photo I.D.