Surrender Application

Red River Old English Sheepdog Rescue, Inc.
Dog Surrender/Intake Request
Please fill out this form to the best of your ability. Your answers will help us get to know the animal and give us background information. This will ensure that we are able to place the animal in a new home that is best matched
with his/her personality and needs.
Any Question Marked With an Asterisk (*) Must Be Filled Out Before Application Can Be Submitted
Your Name*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Email*
Primary Phone Number*

Area CodePhone Number
Alternate Phone Number:

Area CodePhone Number
Animal's Name*
Age*
Date of Birth if Available*
Sex*

MaleFemale
Tail*

YesNo
Approximate Weight *
Is He/She Good With Other Dogs?*

YesNo
Good with Cats?*

YesNo
Good with Children?*

YesNo
House Trained?*

YesNoSometimesNot at all
Crate Trained?*

YesNo
Is Your Dog Destructive?*

YesNo
Leash Trained?*

YesNo
Socialization*

Sweet and socialA little shy but warms upVery shyDefinitely abusedFear biter
Has Your Dog Bitten Anybody? If so, Please Explain.*
Altered (Spayed or Neutered)?*

YesNo
Does Your Dog Jump or Climb Fences?*

YesNo
Is your Dog up to Date on Vaccinations? Please Check all that apply.*

RabiesDistemperBordatellaParvovirusLeptospirosisCoronaParainfluenzaHepatitisI do not know
Has your Dog been Heartworm Tested?*

YesNoI do not know
Does Your Dog Have Heartworms?*

YesNoI don't know
Does Your Dog Have a Microchip? If known, Please provide the Microchip Number. *
Name of Food He/She is Currently Eating?*
What is Your Reason for Surrender?*
Additional Comments:
I hereby represent and warrant each of the following:

(a) That I am the rightful owner of the animal(s) that is the
subject of this Owner Surrender Form,

(b) That I have full and complete authority to convey, surrender and relinquish
the animal(s),

(c) That I am hereby willingly surrendering and releasing any and all of my property rights to the animal(s),

(d) That no other person has a right of ownership or property to the animal(s), that once I surrender the animal(s), the animal(s) may not be returned to me,

(e) By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.
I certify that the above information is correct
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Red River Old English Sheepdog Rescue, Inc.

Dog Surrender/Intake Request