Dog is Pending

Use this form to notify the BRAT Administrators that a dog's placement is pending.
(*) Indicates a required field.

Dog Name *
Dog is Basenji or mix?    Basenji   Mix
What state was the dog rescued from?   
Is the dog listed on BRAT's Web site?    Yes  No
If so, in which state?   
In which home does the dog currently live?    Owner   Foster   Foster-to-Adopt
Coordinator Name *
Coordinator E-mail *
Adoptee Name *
Adoptee Address *
Adoptee City, State and Zip * ,    
Adoptee Phone Number (incl. area code) *  
Adoptee E-mail *
Contract Sent?    Yes  No
New Dog "Do/Don't" Sent?    Yes  No
BRAT Evaluated the Dog?    Yes  No
Fanconi Test Results    Positive  Negative  Unknown
Heartworm Test Results    Positive  Negative  Unknown
Vaccinations   
(check all that have been given)    		Corona  Bordetella  DHLPP  Giardia
 Lyme Disease  Rabies  No vaccines given
Comments   
The new owner may need support because   
(check all that apply)    		Multiple Dogs  Housetraining  Cats  Dominance
 Health Issues  Crate Fear  Separation Anxiety
Comments   
Should dog remain on Website pending the   placement?