This is the page you're looking for if you've been
asked to complete and return a personality profile form by
one of our representatives.
We do not accept a terrier into our rescue without first seeing its
picture.
If you are submitting a personality profile form to
us, you will also need to email a digital picture of your terrier to
either email address at the bottom of this page... or, include an actual
photograph with your form, should you choose to print, complete,
and then return your form to us via the US mail.
Thank you for completing this profile. Your responses will help us in
making the best placement for your terrier.
If you would prefer to work with a printable version of our personality
profile, please choose the appropriate link below:
personality
profile form (pdf format requiring Adobe Reader)
personality
profile form (doc
format requiring Microsoft Word)
To complete our personality profile
online,
please fill out and submit the form below. |
Your first name:
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Your last name:
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Address:
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City:
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State:
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Zip code:
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Email Address:
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Home phone:
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Work phone:
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Cell Phone:
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Terrier's name:
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Terrier's age:
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Terrier's date of birth:
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Terrier's gender:
Male
Female |
Has this terrier been spayed/neutered?
Yes
No |
Terrier's height:
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Terrier's weight:
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Terrier's hair color:
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Type of coat:
Smooth
Broken
Rough |
Why are you considering placing this dog in rescue?
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Where did you get this dog?
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If you got this dog from a breeder, please provide the
breeder's name:
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If you got this dog from a breeder, please provide the
breeder's phone number:
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How many homes has this dog lived at?
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Where is this dog being kept during the day?
Inside confined
Inside loose
Outside confined
Outside loose
Outside kennel
Other |
Where is this dog being kept at night?
Inside confined
Inside loose
Outside confined
Outside loose
Outside kennel
Other |
Extent of this dog being housebroken:
Completely
Almost (being trained)
Paper trained
Crate trained "marks" territory |
Is this dog crate trained?
Yes
No |
Does this dog cry or bark when confined to
a crate?
Yes
No |
How does this dog do riding in a car?
Rides well
Afraid
In crate only
Gets carsick |
Veterinarian's name:
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Veterinarian's phone number:
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Date this dog was last seen by this veterinarian:
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Date this dog last received yearly vaccinations:
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Date this dog last received heart worm preventative:
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Please tell us which brand and type of dog food this dog
receives, as well as, the amount it is given each day:
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Indicate the type of household this dog is in:
Quiet
Fairly quiet
Busy
Very busy |
Indicate which items this dog is protective of:
(check all that apply)
Food bowl
Toys
Rawhide bones
Owner
Furniture
People
Other |
This dog is protective of the above items when it's around:
(check all that apply)
Other animals
Children
Adults |
Has this terrier ever bitten anyone?
Yes
No |
If this terrier has bitten someone, please describe the situation:
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If this terrier has bitten someone, was the person bitten
a child or an adult?
Child
Adult |
If this terrier has bitten someone, did the bite break the skin?
Yes
No |
How does this terrier react to new people?
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How does this terrier react to children?
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How does this terrier react to other dogs?
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How does this terrier react to cats and other animals?
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How does this terrier react to the veterinarian?
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How does this terrier react to the groomer?
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Under what circumstances does this terrier growl?
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Under what circumstances does this terrier snap?
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Under what circumstances does this terrier bark?
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What time(s) of day is this terrier fed?
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Is this terrier allowed on your furniture?
Yes
No |
If you answered 'yes' above, then which furniture is the terrier allowed on?
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What are this terrier's favorite toys, games, and tricks?
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Has this terrier received obedience training?
Yes - formal training
Yes - trained on own
Needs work - refresher
No training |
Indicate which commands this terrier knows:
(check all that apply)
Sit
Stay
Come
Off
Down
Paw
Shake
No
Other |
How has this terrier been corrected when it misbehaves?
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How has this terrier reacted when it has been corrected?
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How much and what kind of exercise is this terrier use to?
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Is this terrier allowed to play rough with people?
Yes
No |
If you answered 'yes' above, please describe:
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This terrier can best be described as:
(check all that apply)
Easy going
Loyal
Friendly
One person dog
Shy
Aggressive
Hyper
Noisy
Protective
Obedient
Active
Quiet
Playful
Outgoing
Destructive
Affectionate
Demands attention
Smart |
Are there any places on this terrier's body that it does not like to have touched?
Yes
No |
If you answered 'yes' above, please describe:
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Please describe any medical problems or conditions this terrier has:
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Thank you for completing this form. Please be aware that any falsification
or misrepresentation of the pet could result in the pet being euthanized.
Please understand that all information, good or bad, IS IMPORTANT FOR THE
PROPER PLACEMENT OF THE PET.
The laws of South Carolina will govern the interpretation and enforcement
of this contract. I, __________, certify that I am the sole owner of the
dog described above and that I have the right to give it away. I further
certify that there are no unpaid veterinary bills or claims on said dog.
I hereby renounce all claims to the above-described Terrier. It is my understanding
that the Coastal Jack Russell Terrier Rescue Committee will do what is
best for the dog. With this instrument the dog becomes the property of
the Coastal Jack Russell Terrier Rescue Committee.
Signed:________________
If this application is sent electronically by use of
the submit button below, I attest that the responses being submitted are,
indeed, mine. Furthermore, I understand that my approval by signature is
assumed. |
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