Dog Information Form
Blind Dog Rescue Alliance (BDRA) recognizes that, due to unforeseen and unfortunate circumstances, owners of blind or visually-impaired dogs may be faced with the difficult decision of surrendering their dog to rescue. If you find yourself in such a predicament and have made reasonable efforts to rehome your blind dog, please fill out the following form with as much detail as possible.
Please note, however, that completion of this form does not guarantee your dog will be accepted into our program or that foster or permanent placement can be made. Please also note that this form is meant to be completed via computer and may not work properly if attempted via phone.  If you have any difficulties completing this form, please email or call 1-877-BLIND-01, extension 4, and we will complete the form with you over the phone.  
If at any point you find that you no longer need our assistance, please let us know.  We understand that circumstances can change, and we ask that you keep us updated.  BDRA is an all volunteer organization, and we appreciate your respect for the time commitments of our volunteers, as well as any potential adopters and/or fosters who may be interested in your dog.  Open communication is one of the keys to the success of any organization.  We thank you for your cooperation and understanding.
Please also note that we do not currently have any foster homes in the western US; however, we will still do everything we can to help, so please complete the form with as much detail as possible.  

Information on your blind or visually-impaired dog

Size *
Sex: *
Neutered or spayed? *
Does your dog have a registration or microchip number? *

Your dog's temperament and behaviour

Is your dog *
Is your dog housebroken? *
Is your dog leash-trained? *
Is your dog (please check any traits that apply) *
Do you own any other animals? *
Is your dog possessive with treats, toys, or food? *
Has your dog ever bitten or snapped at anyone and/or at any other animal? *

Your dog's medical history

* Please advise your vet that we will be calling and give her/him permission to speak with us
Is your dog current with vaccinations? *
Has your dog had a heartworm test? *
Has your dog seen a veterinary ophthalmologist? *

In the event a foster home is not found within BDRA, I give permission for my dog to be networked/crossposted via email, websites and Facebook to help my dog find other rescue and/or an adoptive home. I acknowledge BDRA will be listed as the contact and will forward any inquiries to me.  I also acknowledge that BDRA will do their best to screen any potential adopter's vetting, but may not be able to do so.  I understand BDRA is not able to screen any potential adopters or rescues in any other way, and that BDRA is not able to help with transport.
I give permission for my contact information to be shared with other rescues only. *

I  certify that the information I have provided is true and correct.

I certify that I am the legal owner of the dog described above, or that I am completing this form on behalf of the owner of the dog described above, and with the owner's knowledge.

I understand that submission of this form does not guarantee that my dog will be accepted into the Blind Dog Rescue Alliance program or that foster or permanent placement can be made.
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