Owner Surrender Form
If you're an owner wishing to surrender you personal dog please fill out this form. This form gives us all of the crucial information we need about the dog to assess how we will be able to best help you and your dog.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Dog's Name
*
Dog's Age
*
Dog's age when it came to live with you
*
Please describe why you wish to surrender your dog
*
Please explain the remedies you have tried to resolve the situation?
Is the dog current on vaccines? (with provable documentation)
*
Yes
No
Is the dog spayed or neutered?
*
Yes
No
What is your vet's name or vet practice name?
ABC Vet Hospital
What is your vet's phone number?
Please enter a valid phone number.
When was the last time your dog was at the vet?
-
Month
-
Day
Year
Date
Is the dog friendly with other dogs?
*
Yes
Yes - but dog selective
No
Unknown
Is the dog people friendly? (Meaning anyone can handle the dog)
*
Yes
No
Unknown
Is the dog good around cats?
*
Yes
No
Unknown
Is the dog good with children? (Select all that apply)
*
Yes - good with younger children
Yes - good with older children
No
Unknown
Does the dog have a bite history?
*
Yes - bite was reported
Yes - bite was not reported
No
Please explain the circumstances surrounding the bite and who the bite was reported to if applicable.
*
Does the dog exhibit any toy or food resource guarding/aggression? (Select all that apply)
*
Yes - Issues with toys
Yes - Issues with food
No
What your dog's best traits?
What your dog's worst traits?
If you had a house party, which would apply to your dog?
*
Life of the party - well mannered and greeting everyone politely
Hiding away from the crowd in another room
Needs to be contained because he/she is unpredictable
In a crate till all the people are settled then dog is welcome to wander the party.
None of these
Other
Where does your dog sleep?
Yard, Basement, Crate, Couch, My bed, Dog House
Is there any other information that you would like us to know?
*
When you take your dog for a walk it is:
Like going waterskiing - being dragged
Nice and easy until he sees something he wants
Shy walks slowly and is afraid of everything, cars, people, other dogs, noises
Like a professionally trained heeling dog
Please upload pictures of dog you wish to surrender
*
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