misfitmanor.com

Surrender Request
Name
Contact Phone Number
Email Address
Location
Dog's Name
Sex (male or female)
Is Dog Spayed/Neutere?
Breed
Weight
Approximate age or birthdate
Where did you get the dog?
How long have you owned the dog? Have they had previous owners
Where does the dog sleep at night?
Where do you keep the dog when you leave the house?

Loose in the houseRestricted to one or two roomsIn a cage or crate indoorsLoose outdoorsTethered outdoorsIn a kennel outdoors
Is the dog housebroken?
Is the dog crate trained?
Is the dog destructive when left alone?
When left alone does the dog:

BarkChew furnitureChew personal items (shoes, clothes etc)Scratch and dig doors and windowsillsPee or poop in the houseNone of the above
When allowed outside the dog is:

Chained in yardLooseIn fenced yardIn kennel
When allowed outside unsupervised the dog:

Dig holesEscape frequentlyBark continuouslyBark at strangersBark at other animalsSeems content
Has the dog been consistently around children? If yes, please list ages of children:
Is the dog too rough when playing with kids, or does it play politely?
Have the dog’s experiences with children always been positive? (please explain)
Has this dog ever lived with cats? Does it like cats? Has the dog ever hurt a cat?
Does the dog get along with other dogs?

AlwaysUsuallySometimesNever
Is the dog from a single dog household? If no, please list the ages, sexes, and sizes of the other dogs
Has the dog ever been allowed to play with other dogs?
Has it ever been in a dog fight in which either dog was injured? If yes, explain
When new visitors enter the house?
You take away it’s favorite toy or bone?
Its disturbed when sleeping in its favorite spot?
You take away its food?
Would you say that most of the time your dogs is:

FriendlyPlayfulShyWithdrawnProtectiveAffectionateHyperActiveAggressiveStubbornNoisyQuietDestructive
Who does your dog prefer?

ChildrenTeenagersMenWomenElderly
Is your dog afraid of:

VisitorsLoud noisesThunderBeing aloneVacuum cleanerKidsMenGoing to the vetOtherNo fears I am aware of
Will your dog let you groom it?

YesNo
Bathe it?

YesNo
If no to any of the above please explain
What, if any, behavioral problems does the dog have?
Has the dog ever bitten a person for any reason?(Please know that this question does not necessarily determine the outcome of the dog.) If yes, please describe the circumstances:
What are two things you like most about the dog’s behavior?
What are two things you don’t like about the dog’s behavior?
Why are you surrendering this pet? (Please give detailed explanation of why)
What would have to happen for you to keep this dog?
Any additional comments or information:
Who is your dog's vet?
Does your dog have any medical problems? If so, please describe.
What health conditions has your dog experienced in the past?
Is it on any medications? If so, please describe.
When was your dog’s last vaccination? Rabies?
*A voluntary contribution towards the future care of your dog is always appreciated and can be accepted at time of surrender or e-transferred to misfitmanordogrescue@gmail.com
Please include a picture of your dog
Should be Empty:

Surrender Request