Owner Surrender Questionnaire
Owner Surrender Questionnaire
the Name of the Bull Terrier
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Do you know who your bull terrier's breeder is? If so what is their name?
*
Please describe any health concerns & the name address of your dog's primary veterinarian.
*
Veterinarian's Name & Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veterinarians Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age or Date of Birth
*
Color
*
Gender
*
Spayed Female
Intact Female
Neutered Male
Intact Male
Unsure
Reason for Surrender
*
What is his/her Energy Level
*
Pick as many that apply
*
My dog is dog friendly
My dog likes some dogs but not others
My dog likes dogs in the home but is reactive outside
My dog only likes dogs outside the home
My dog doesn't like other dogs
Unsure
Other
Explain your choices above
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What is his/her play style with other dogs
Is he/she cat friendly?
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Describe his/her prey drive (rabbits, squirrels, birds, small animals or large animals ie swine, goats, cows horses)
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How is he/she with human children
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Can he/she live in an Urban environment/City?
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Has he/she ever been aggressive or fearful with humans?
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Has he/she ever bitten someone (if yes please explain all events in detail)
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Is he/she leash trained?
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Is he/she housebroken and what are his or her potty habits (does he/she go in the yard or on walks)
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How many hours is he/she alone during the day
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Is he/she destructive? Does he eat things he shouldn't? If so please explain.
*
Where does he/she sleep at night
*
Is he up to date on his or her shots (vaccines)
*
Does he/she display any compulsive behaviors like chasing his own tail, chasing shadows, ball or toy obsession or having difficulty being left alone.
*
Does he/she have a special diet?
*
Does he/she have any behavioral oddities, special likes or dislikes, or quirks?
*
How long can you safely keep the dog until we find appropriate placement?
*
Is there any other relevant information you feel we should be aware of at the Bull Terrier Rescue Mission?
Submit
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