DANE EVALUATION FORMPlease fill out all information completely for the Dane that was evaluated. Volunteer's Name * First Name Last Name Date of Evaluation * MM DD YYYY Dane's Current Owner Name * Dane's Current Address (include city, state, zip) * Dane's Current Owner Phone Number Dane's Current Owner Email Name of Dane Age of Dane Color of Dane Spayed or Neutered? Yes, spayed/neutered No, not altered yet Sex of Dane Female Male Reason for Surrender Please provide details as to why the Dane needs to be surrendered and a time frame for surrender. Name of Breeder Contact info for Breeder Has breeder been contacted? YES NO Other info about breeder Does the Dane have "papers"? CONDITION OF DANE Ears CLEAN DIRTY Eyes CLEAR DISCHARGE/PROBLEM Skin GOOD DRY MANGE Nails TOO LONG TRIMMED Weight UNDERWEIGHT OVERWEIGHT NORMAL Thank you!
