Surrender Form
Name
First Name
Last Name
Phone Number
City
State
Email
Have you made the final decision to surrender the dog?*
Yes
No
Dogs Name*
Dogs Age*
Gender*
Male
Female
Is the dog spayed/neutered?*
Yes
No
Unknown
Is the dog a full blooded pug?*
Yes
No
Unsure
If you answered "no" to the above, please tell us what your pug is mixed with?
Is the dog housebroken?*
Yes
No
Partially
Is the dog crate trained?*
Yes
No
Don't Know
How long have you had the pug?*
Is your dog current on vaccines? If yes, which ones?*
Has the dog been kept on heartworm prevention?*
Yes
No
Don't know
Veterinarian Office Name and Phone Number*
Does your dog have any medical conditions that you are aware of?
Note: We do not turn away dogs that have medical conditions so please be truthful so that we can make sure the dog gets appropriate care for their condition
Is the dog on any medications? If so, which ones?
Does the dog have any allergies that you know of? If so, what are they?
Is the dog good with children?
Yes
No
Don't Know
Is the dog good with other dogs?
Yes
No
Don't Know
Is the dog good with cats?
Yes
No
Don't Know
Has the dog ever bitten anyone?
Yes
No
Don't Know
Why are you surrendering the dog?
Any other information about the dog that you can tell us that will make this transition easier for him/her? Likes/Dislikes?
We will work to take the dog into rescue as quickly as possible. Please tell us how urgently you need to place the dog in rescue. This is just a guide and we cannot guarantee we can accommodate so please be patient and as flexible as possible.*
Emergency
1-2 Weeks
2-3 Weeks
3-4 Weeks
4+ Weeks
If you are able to help at all with transport it might assist us getting the dog into rescue faster. If so, how far are you willing to travel?
How did you hear about Pawsitively Pugs Rescue?
Internet
Friend Referral
Vet Referral
Event
Other
By clicking agree I signify that I am the legal owner of this dog and that I understand that once the dog is surrendered to PPR the dog will not be returned to me for any reason. I also am agree that PPR can call the veterinarian and obtain the dogs records. Note: If you can provide copies of the vet records the intake process will move along quicker.
Agree
Disagree
Submit
Should be Empty: