Owner Surrender Form
We realize there are many reasons to relinquish a dog and we respect your decision. Our mission is to be a sanctuary home for hospice pugs, and to find a new forever home for other pugs in need. Please help us provide great care for this pug by thoroughly completing the following information:
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
Male or Female?
Please Upload a Photo of the Dog You Wish to Surrender
Drag and drop files here
Choose a file
Brief History of Your Pet
Any Known Medical Issues
On Any Medications?
Spayed or Neutered?
Reason for Surrendering:
Have You Ever Bred This Dog?
To the best of your knowledge has this dog ever bitten anyone or shown potential to bite?
Where did you acquire this dog?
How many years have you owned this dog?
How many hours a day is the dog left alone?
Is the dog housebroken? Outdoor only? Piddle pad trained?
Does the dog live with other animals and/or children? Check all that apply:
Where does it stay during the day? Where does it sleep at night?
When left alone does the dog…(check all that apply)
Is your dog afraid of (check all that apply):
Please review and sign below acknowledging the following:
∙ The above information reflects the animal in which I am surrendering to Vintage Pug Senior Sanctuary.∙ I am the owner of this animal and have full right to surrender him/her∙ I understand that I cannot ask for this animal back after this form is submitted to Vintage Pug Senior Sanctuary and this animal is now under the complete ownership of Vintage Pug Senior Sanctuary.∙ My signature below reflects that I have read and understand the information provided above and I am hereby releasing all rights for this animal to Vintage Pug Senior Sanctuary
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