Primary Adopter's Name *

First Name

Last Name

I understand that 4PSR does not recommend this dog to interact with one or more of the following: *

Children

Dogs

Cats

Other Small Animals

I understand that this dog's behavior around cats or small animals is unknown *

I understand

I understand that this dog is not recommended to be off leash outside of the home *

I understand

I understand that this dog has shown resource guarding behavior towards one or more of the following: *

Dogs

People

Other Animals

I understand that this dog has displayed territorial aggression in one or more of the following contexts: *

In Home

In Public

I understand that this dog may require caution when meeting new people and/or strangers. *

I understand

I understand that this dog has bitten a human. *

I understand

I understand that this dog has shown separation anxiety. *

I understand

I understand that this dog is pregnant or nursing puppies and should not be allowed to meet or interact with other animals in the home or while out on walks. *

I understand

I understand and agree that I must continue to work with a professional trainer on the dog’s behavioral issues *

I understand

Electronic Signature *

First Name

Last Name

Date *

MM

DD

YYYY