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If you know of a Bichon that needs to be
placed with a Rescue Volunteer, please fill out the following form.
Please also download and
fill out the Veterinary Record
Release Form (PDF) and have this completed at the time the Bichon is
picked up.
If you are not certain, please put "unknown" or "n/a". Thank you!
Where is the Bichon?
Owner's Home, Foster Home or Shelter?
City, State and Zip
Country, if not in the USA:
Bichon's Name or Shelter ID:
Gender:
Spayed/Neutered:
Age: (State if Estimated or Unknown)
Has the Bichon ever bitten anyone?
If Yes, under what circumstances?
(Dates occurred, number of
times, adult, child, family member or stranger, dog provoked, dog in a crate or backed up
in a corner, dog ill, dog eating, dog fearful, dog aggressive, etc.)
Bichon's Health or Health Care
Requirements:
Describe in detail whether the dog is known to be or appears to be healthy, OR if there
are any known or apparent health problems (heartworm, kennel
cough, parvovirus, blindness, cataracts, deafness, paralysis, ringworm, demodectic mange,
ear mites, tape worms, hypothyroidism, Cushing's or Addison's disease, autoimmune diseases, cancers,
heart diseases, pancreatitus, gastritis, seizures/epilepsy, patellar
luxation, hip dysplasia, ruptured discs, bladder stones, severe gum disease, severe
inhalant or flea allergies, etc.) Also, describe in detail any known or apparent short term or long term health care
requirements/costs (medications required, frequency,
treatments, surgeries required and costs if known, special foods and diets, etc.)
Has the Bichon been tested for
heartworms?
If tested, what were the results?
Date of Test:
Is Proof Available?
Bichon's Physical
Characteristics/Appearance:
(Missing
an eye, missing a limb, extremely dirty and/or matted and needs shaving/bath, already
shaved and bathed, missing hair due to trauma or disease, rashes; Or in fairly good to
great condition: not matted, basically clean and groomed, well cared for, etc.)
Is the Bichon Housebroken?
(completely housebroken, rarely accidents,
frequent accidents, circumstances surrounding when accidents occur)
Has the Bichon been around children?
(number of children, ages, sex, lived with or exposed,
frequency, good or bad experiences with children, etc. )
Has the Bichon
been around other animals?
(types of animals, number, sex,
spayed/neutered, lived with or exposed,
frequency, good or bad experiences with which animals, etc.)
What is the
Bichon's general temperament?
(aggressive,
shy, fearful, quiet, timid, barks excessively, good or bad with strangers, prefers male or female humans,
fearful or aggressive with children, fearful or aggressive with other animals,
etc.)
Reason this
Bichon is being placed into rescue:
Urgency of
Rescue:
How long can
the dog be maintained until a rescue volunteer needs to take possession?
Information About You:
Name:
Organization:
Email:
Are you the Owner/Guardian of the
Bichon?
If No, please give
the Owner/Guardian's Information:
Name:
Email:
How long has the current owner had this
Bichon?
How and where was this Bichon obtained?
(purchased,
gift, adopted; From whom: Breeder's Name, Store's name, Shelter's Name, address, phone
number, etc.)
Is this Bichon
registered (AKC, CKC, etc.)?
If yes, can
registration papers be provided?
Is this Bichon
microchipped or tattooed?
Is there a crate in
good condition that can be provided along with the Bichon?
What kind or brand of
food was the Bichon fed?
Does the Bichon have current Rabies vaccination?
Also state
Date, if known (MM/DD/YY):
Current DHPP or combo vaccination?
Date, if known (MM/DD/YY):
Current Bordatella vaccination?
Date, if known (MM/DD/YY):
Can you provide proof of these
Vaccinations?
Is the Bichon currently on Heartworm
prevention?
Brand given/frequency,
Date last given (MM/DD/YY):
I hereby give permission for the Veterinarian listed below
to release to the Bichon Frise Club of America Charitable Trust's designee
all medical records for the dog named on this form.
(Initial in this box to grant permission:)
I certify that the Veterinarian and Clinic listed below are
the current medical providers for this dog, and that the records they
provide will be the most current and complete records available.
(Initial in this box to certify:)
Veterinarian Information:
Name:
Clinic/Hospital Name:
Email:
Any additional comments?
Before you click the button, please read this:
From the moment we receive your information, we take action.
Arrangements are made for transport, a foster home, and more. We make every
effort to work with you to re-home the Bichon.
Please remember, however, that we are all volunteers, with
jobs, families and commitments. We will do our best to respect your time,
and only ask the same in return.
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