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:
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Dog’s Name
Male or Female?
Male
Female
Please Upload a Photo of the Dog You Wish to Surrender
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Brief History of Your Pet
Any Known Medical Issues
On Any Medications?
Overall personality/demeanor
Spayed or Neutered?
Yes
No
Reason for Surrendering:
Have You Ever Bred This Dog?
Yes
No
To the best of your knowledge has this dog ever bitten anyone or shown potential to bite?
Yes
No
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:
Dogs
Cats
Kids
Other animals
Where does it stay during the day? Where does it sleep at night?
When left alone does the dog…(check all that apply)
Bark
Chew
Scratch
Urinate/defecate indoors
Is your dog afraid of (check all that apply):
Storms
Loud noises
Strangers
Vet
Car rides
Other
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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