Dog/Puppy Surrender Form

THAR Surrender Form- Dog
Date

MonthDayYear
Date
OWNER DETAILS
Name
Address
Phone
Email
example@example.com
DOGS DETAILS
Dogs Name
Gender
Approximate age or DOB
Breed
Colour
Dogs age when he/she arrived into your home
Where did you get the dog (breeder, RSPCA, giveaway etc)
ANIMALS HEALTH HISTORY
Is the dog desexed
Is the dog up to date with vaccinations
Is the dog microchipped
Please provide microchip number
Has the dog had any previous health concerns
Does the dog have any current health concerns
DOGS PERSONALITY & BEHAVIOUR
Is the dog good with cats (please elaborate)
Is the dog good with other dogs (please elaborate)
Is the dog good with children
Is the dog an escape artist (jumps fences, digs under fences etc)
Has the dog ever bitten a person or harmed another animal
Is there anything else you would like us to know about the dog
What is your reasoning for wanting to surrender the dog
By signing this surrenderform, you are agreeing to the following;

-All information stated on this document is true and correct at the time of submission and that you have in no way provided any false or misleading information potaining to the animal in question.

-Upon acceptance of this form, a microchip ownership transfer form (if the animal is already microchipped) will be promptly emailed to you, for your immediate attention. Upon completion of this form, ownership of the animal is immediately given to Touching Hearts Animal Rescue Inc.

-Upon acceptance of this form, a $100 surrender fee for undesexed dogs or a $75 surrender fee for desexed dogs or dogs under 6 months of age will be payable to Touching Hearts Animal Rescue immediately.
SIGNATURE
Signature
Date

MonthDayYear
Date
Should be Empty:

THAR Surrender Form- Dog

OWNER DETAILS

DOGS DETAILS

ANIMALS HEALTH HISTORY

DOGS PERSONALITY & BEHAVIOUR

SIGNATURE