BTRCF Surrender Form

Bull Terrier Rescue of Central Florida, Inc. Surrender Form
I UNDERSTAND THAT BY COMPLETION AND SUBMISSION OF THIS SURRENDER FORM I RELINQUISH MY RIGHTS AND OWNERSHIP OF THE DOG DETAILED BELOW TO BULL TERRIER RESCUE OF CENTRAL FLORIDA. *THIS DOES NOT GO INTO EFFECT UNTIL THE DOG IS IN POSSESSION OF THE RESCUE.

ALL QUESTIONS WITH * ARE REQUIRED. You MUST provide answers for the form to go through, even to write "NONE" or "N/A". You will receive a pop-up screen that confirms application was submitted successfully. If not, go back to ensure all required questions were answered.
Please upload a current photo of your dog *

Browse Files

Cancel of
Today's date: *

Month Day Year
Dog's Name *
Dog's Age *
Dog's Gender *

Male Female
Dog's primary coloring *
Dog's approximate weight *
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip
Phone Number *

Area Code Phone Number
Email *
example@example.com
I hereby voluntarily relinquish all claims and ownership of said dog to the organization known as Bull Terrier Rescue of Central Florida. Inc. (BTRCF) and members thereof. I have answered all parts of this surrender honestly and truthfully & cannot reclaim this dog once the dog is in the possession of BTRCF and understand that this animal will be spayed or neutered, if needed. I agree to give up the dog's American Kennel Club registration papers and all medical records available. Neither rescue nor members thereof shall be held responsible for actions of the adoptive or foster family and/or dog. The dog may be euthanized for extreme aggression or illness if BTRCF deems it necessary, but this is always a very last resort after all other measures have been exhausted. *

Agree
Is your dog aggressive to humans and has bitten or attacked a human? *

Yes.- my dog has bitten/attacked or been aggressive to a human. No- my dog has NOT bitten/attacked or been aggressive to humans.
If your dog is aggressive to humans and has bitten or attacked, please explain the scenario(s).
Name, address, phone number of the breeder or person you got the dog from: *
How long have you owned this dog? *
Why is this dog being given up? *
Name, address, phone number of the veterinarian who lasted treated this dog: *
Is the dog neutered or spayed? *

Yes No Not sure
The following questions will be of help to the person who will adopt your dog. If there is anything you would like to add that may make your pet's adjustment to a new home easier, please feel free to share that information at the bottom of this form. We want to make the adoption a success and will work hard to have happy owners and happy dogs.
Check the words that best describes your dog: *

Friendly Protective Shy Noisy Quiet Active Playful Nervous Smart Affectionate Aggressive (to other animals) Obedient Calm Aggressive (to people)
Is the dog up to date with all vaccinations? *
Rabies, Bordetella, DHLPP, Lyme, others
Dates of Vaccinations: *
Rabies, Bordetella, DHLPP, Lyme, others
Date of last Heartworm Test? *
Heartworm Test result: *

Negative Positive Not sure
Is the dog on Heartworm prevention? *

Yes No
Brand of Heartworm Medication: *
Date of Last Heartworm pill? *
Date of last fecal exam for parasites: *

Month Day Year
Date
Fecal exam results: *
If positive, was the dog treated?

Yes No
Medications the dog is currently taking: *
Is the dog housebroken? *

Yes No
If partly, please describe when accidents occur:
Are there behavior concerns? *

Yes No
If so, what are they?
Does the dog get along with other dogs? *

Yes No Other
Cats? *

Yes No unsure
Other animals? *

Yes No unsure
Does the dog like children? *

Yes No unsure
Are there children in the home? *

Yes No
If yes, what are their ages?
What brand of food is the dog fed? *
How much is the dog fed? *
How often is the dog fed? *
Are there any specific feeding instructions you wish to share with the new owner? *
Where does the dog sleep? *
Is the dog allowed on the furniture? *

Yes No
Is the dog crate trained? *

Yes No
Where do you keep your dog during the day? *
At night? *
How does the dog react to being left alone? *
Is s/he afraid of anything in particular? (thunder, men, brooms, vacuums, uniforms, etc.) *
Describe any training the dog has had, or tricks learned *
Does the dog have any health problems? *

Yes No
If yes, please describe: *
Does the dog like riding in the car? *

Yes No
Is your dog microchipped? *

Yes No
Microchip number: *
What is the dog's favorite toy or plaything? *
Favorite things to do? *
Likes/ dislikes of the dog: *
Does the dog jump kiddie gates or fences? *

Yes No
If yes, indicate how high the dog jumps:
Is the dog a digger? *

Yes No
Is there anything else you can share that is special, unusual or endearing about your dog that would help the new owner?. *
Will the dog be surrendered with any items? *
medicine, food, harness/collar, leash, toys, etc.
Are there any other things you think a new owner needs to know? *
Owner signature *

Clear
Date & Time form was signed and submitted *
Should be Empty:

Bull Terrier Rescue of Central Florida, Inc. Surrender Form