LYR Owner Surrender Form

Owner Surrender Form
Little Yorkie Rescue

Donna Rickard /Lorain, OH 44053 Email: littleyorkierescue@yahoo.com

Website: www.littleyorkierescue.org
Please complete one form for each animal being surrendered. Little Yorkie Rescue makes every attempt to find safe and loving homes for the adoptable pets surrendered to us. Please fill out the form entirely. If admitted, the detailed and accurate information you provide us makes it easier for us to place your pet in an appropriate home.
Name:*
Address:*
City/State:*
Zip:*
Contact Number:*
Work Phone:
Email Address:*
example@example.com
Pet's Name / Nicknames:*
Sex: Male Female Age:*
Breed:*
More Details about Your Dog

PLEASE BE VERY SPECIFIC WITH YOUR ANSWERS SO THAT WE CAN PROVIDE THE BEST CARE FOR AND FIND THE BEST SUITABLE HOME.
Where did you get your dog?
Is your dog spayed or neutered? Yes No
How long have you owned your dog?
Why are you surrendering your dog?
Is your dog destructive when left alone? Yes No
If yes, please explain:
Is your dog house trained? Yes No Is your dog crate trained? Yes No
What cues does your dog know, if any?
Has your dog had previous training? Yes No
What veterinary does your dog go to?
When was your dog last at the vet?
When was your dog last vaccinated?
Does your dog have any known health related issues? Yes / No
If Yes please explain.
Has your dog been on Heartworm preventative? Yes / No What kind?
When was your dog last tested for Heartworms?
What was the test result? Positive / Negative?
When was it last given?
Does your dog currently live with children? Yes / No If yes, what ages?
Please describe your dog's experience with children:
How Does Your Dog React?
To strangers?
To visitors in the home?
If you try to take away a toy or bone?
If you take your dog's food while eating?
If your dog is disturbed while sleeping?
Any additional comments:
Does your dog live with other dogs? Yes / No How many?
If Yes, What are the age/sex/breeds ?
Does your dog get along with other dogs? Yes / No
If yes, please explain your dogs experience with other dogs:
If no, please explain:
Does your dog get along with other type animals? Yes / No
Does your dog live with cats? Yes /No
If yes, please explain your dog's behavior with cats:
Does your dog have behavior issues? Yes / No
If yes, please explain:
Does your dog have any fears? Yes /No
If yes, please list all:
How does your dog react: When being seen by a veterinarian?
When being groomed?
To having his/her nails trimmed?
Has your dog ever bitten anyone? Yes / No
If yes, did it break skin? Yes No
Was a bite report filed? Yes/ No
Please explain the bite incident:
Please list a few things you like best about your dog:
Why do you think your dog would be a good candidate for adoption?
Does your dog have any food aggression? Yes / No
If Yes explain.
By signing this form, I state that I am the owner of the animal who is the subject of this Animal Surrender Form. To my knowledge, no other person has a right to this animal. I hereby surrender all rights to this animal. I understand that once I relinquish this animal, the animal will not be available to be returned. I have read and understand the terms of this Animal Surrender Form.
Signature / All forms of a signature, even those that are not legible or just an ( X ) will be accepted as your signature and your acknowledgement of the surrender of the animal. For best results use a stylus if one is unavailable use your fingertip. *

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More Details about Your Dog

How Does Your Dog React?