Release Form

Thank you for your interest in giving up your Airedale for adoption through Airedale Rescue Group. Please fill out this form completely. All fields are required. Also a cute picture or two should be emailed to us at info@airedalerescuegroup.com for the website. We serve North and South Carolina, Georgia, Tennessee, and Alabama and assist as requested by Airedale Rescue groups serving that state.

Name *

Telephone *

Alternate telephone

Address *

City *

State *

Zip *

Email *

Alternate email

Name of dog *

Male or Female? *

Male

Female

Have you had the Airedale since it was a puppy? *

Yes

No

If not, how did you acquire the Airedale? *

Neutered/ Spayed? *

Yes

No

Age/ Birthday *

AGE DD/MM/YYYY

AKC papers? *

Yes

No

Weight *

Reason for giving up Airedale. Please be specific. *

Dog currently lives with: * a) number of adults: b) if children, age of children: c) if pets or other animals, types, and ages: d) other important living conditions:

Airedale is (check all that apply to your Airedale)

Living in a home (Inside dog; lives inside except to potty or play outside)

Outside dog (lives outside; rarely in the home)

Chained outside, but has a dog house

Fenced yard

Trained to an electronic fence

Uses dog door

No fencing; is leash walked

Escape artist (explain below)

Airedale Crate Training & Hours Alone (check all that apply to your Airedale) *

Crate trained - uses it occasionally

Crate - hates it, freaks out, refuses to be crated

Crate: always crated when we are not home

Crate: crated overnight when sleeping

Crate is an airline kennel

Crate is an wire kennel

Crate not used; dog has free run of home

Used to being alone 0-2 hours

Used to being alone 4-6 hours

Used to being alone 6-8 hours

Used to being alone 8+ hours

Airedale behaviors (check all that apply to your Airedale)

Digs huge holes in yard

Housebroken

Barks at everything

Barks when someone new enters our home

Leash: Good leash walker

Leash: Bad on leash (not leash trained, pulls when on leash)

Leash: Reactive to other dogs when on leash can be controlled or redirected (barks, lunges)

Leash: Reactive to other dogs when on leash CANNOT be controlled (barks, lunges)

Grooming: Loves it

Grooming: Hates it

Grooming: Tolerates it (fussy about paws, face, behind or other part of body)

Car: Good in car - loves it

Car: Bad in car - hates it (gets sick, will not settle, barks at people, cars/trucks, other animals)

Food: Good eater

Food: Won't eat most days, Picky or Slow Eater

Food: Allergic to certain foods (specify below)

Special medical condition (fill in "any other medical treatment" field below)

Airedale Interactions (check all that apply to your Airedale) *

Sweet dog, loves to cuddle

Timid or shy, fearful of some people

Fearful of men

Fearful of women

Afraid of thunderstorms

Afraid of loud noises

Children: Loves all children any age

Children: Never been around children; only seen from distance

Children: Does best with older children 10 yrs to teenagers

Children: Not good, afraid of kids

Cats: Never been around cats

Cats: loves cats

Cats: Hates cats - wants to chase or eat them

Cats: OK with cats (will tolerate and live peacefully with a cat)

Dogs: Loves dogs

Dogs: Hates dogs

Dogs: Good with small dogs

Dogs: NOT good with small dogs

Dogs: Good with other dogs (can live peacefully with other dogs)

Mouthy (uses mouth on hands or arms or person, but does not bite)

Resource guarding (controls access to food, objects, people and locations that are important to him/her)

Dominant to other household animal(s)

Bites or has a bite history (explain below)

Aggressive to other dogs (hostile, injurious, or destructive behavior toward another dog)

Aggressive to people/kids (hostile, injurious, or destructive behavior toward an individual)

Any other medical condition or treatment

Explain the dog being an escape artist (escapes from fenced area, sneaks out doors):

Dog's best qualities are: *

Dog's worst qualities are: *

Has Airedale received any obedience training? If yes, please describe. *

If you used a trainer, please supply name, address and telephone number

Has dog ever bitten a person or dog? If yes, please describe when and the circumstances *

Veterinarian's Name, Address and Telephone number. List whose name the records are under. *

Airedale was vaccinated and/or tested for * a) Rabies YR: b) DHLP-P date: c) Intestinal parasite exam; worms test date: Results & Treatment: d) Bordetella vaccine date: e) Heartworm test date: Results & Treatment, if any: f. Heartworm medication used: Last date given: g) Flea/Tick preventative used: Last date given: How often? h) Does your Airedale have a microchip? If yes, issuing company name and number:

Food Name: Amount: How often?

My dog has allergies to (check all that apply to your Airedale)

Wheat

Beef

Fish

Chicken

Dairy

Soy

Lamb

Corn

Other (describe below)

Other allergies

If dog receives supplements, describe what and how often

What kind of injuries has your dog had? Describe here *

What kind of medical issues has your dog had? Describe here *

What type of ongoing medication does your dog take, for what ailment? Describe here *

Image of the Dog

Drop a file here or click to upload Choose File

Maximum upload size: 33.55MB

Veterinary Record

Drop a file here or click to upload Choose File

Maximum upload size: 33.55MB

How soon does the dog need to be out of the home *

Dog can stay here until ARG finds a foster or adopter

Up to 2 weeks

need the dog out of the home quickly (this may result in boarding the dog)

I certify ownership of the Airedale described above. This Airedale has not bitten any person or animal within 15 days and has not been exposed to rabies. I give complete ownership of the Airedale to Airedale Rescue Group and release its volunteers and representatives of all liabilities of said dog. I give my permission for volunteers to contact my veterinarian including if applicable Banfield Veterinary Clinic, groomer and trainer for information pertaining to this dog.

"Digital Signature": By submitting this form, I certify that the information provided on this form is true and accurate. * Full name: Date:

If you are human, leave this field blank.

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