Non-Sun & Sand Goldens Dog/Puppy Surrender Form
Answering these questions will assist me in placing your dog in another home so please answer truthfully. You may skip any questions you do not know answers to or cannot answer. Please know there is no judgment here I am only trying to help. I know how hard it is to rehome a dog, you have my deepest apologies and I swear I will do what I can to find them their next best home. - Corinne xoxo
Name
*
First Name
Last Name
Phone
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DOG & HOUSEHOLD INFORMATION
When do you need to surrender the dog?
*
Dogs Name
*
Sex
*
Male
Female
Age
*
Is the dog
*
Purebreed
Mix
Tail
Docked
Natural
How long have you had the dog?
Where did you get the dog?
Why are you surrendering the dog?
What other animals did the dog live with?
no other animals
dogs
cats
Other
BEHAVIOR
Your dogs usual behavior
How does the dog usually behave towards people they know?
Rows
never encounter
friendly
afraid
show teeth/growl
snaps
bites
other
men
women
children
How does the dog usually behave towards people they DO NOT know?
Rows
never encounter
friendly
afraid
show teeth/growl
snaps
bites
other
men
women
children
How does the dog usually behave towards animals they know?
Rows
never encounter
friendly
afraid
show teeth/growl
snaps
bites
other
dogs
cats
How does the dog usually behave towards animals they DO NOT know?
Rows
never encounter
friendly
afraid
show teeth/growl
snaps
bites
other
dogs
cats
Comments on answers above
How does the dog usually react when an unfamiliar person approaches or enters the yard or house?
friendly
afraid
barks
shows teeth/growls
will bite
Is the dog housetrained?
*
yes
no
partially
How does the dog let you know they need to go out?
Where does the dog spend the majority of their time?
*
inside the house, runs free
inside the house, crated
outside the house, runs free in yard
outside the house, kennel
outside the house, tied up
Other
How many hours a day is the dog left alone without a human?
never
1-3 hours
4-8 hours
9-12 hours
over 12 hours
When left alone, is he/she...
outdoors
free roam in home
confined to a room
crated
Other
When left alone, does dog usually show any of the following behaviors?
destroy household items
urinate/defecate
bark
cry
none of these
Other
When the dog plays, do they typically...
jumps
growls
barks
bites lightly
bites hard
none of these
Other
What toys does the dog like?
balls
frisbee
plush
squeaky
tug toy
none
Other
What games does the dog like?
fetch
tug
chase
wrestling
none
Other
Is the dog scared of anything
yes
no
If yes, please explain
Please tell us the dogs bad habits
Is the dog allowed on furniture?
yes
no
Where does the dog usually sleep at overnight?
crate
floor
your bed
couch
kids bed
dog bed
outside
Other
What commands does the dog know?
no commands known
sit
down
stay
come
leave it
place
heel
Other
Describe the dogs leash skills
Describe the dogs reaction if a person or other dog gets near or attempts to take food he is eating.
Describe the dogs reaction if a person or other dog attempts to take a toy they are playing with.
Describe the dogs reaction if a person or other dog attempts to take a bone or other treat they have
Describe the dogs reaction if touched when sleeping.
Does the dog have problems riding in car?
yes
no
don't know
If yes, please explain
Has the dog escaped your property 2 or more times in the last 6 months?
yes
no
If yes, please explain
AGGRESSIVE BEHAVIOR
(behavior that has ever happened)
Has the dog ever attacked or bit a person?
*
yes
no
If yes, please explain
Has the dog ever attacked or bit another dog?
*
yes
no
If yes, please explain
Has the dog ever attacked or bit a cat?
yes
no
If yes, please explain
Has the dog ever attacked or bit farm animals? (chickens, horses, cows, goat, pig, sheep, etc...)
yes
no
If yes, please explain
MEDICAL
Please list all veterinarians that have seen the dog, including address and number.
Does the dog see a veterinarian at least once a year?
yes
no
Is the dog spayed/neutered?
yes
no
What vaccinations has the dog recieved?
rabies
dhhp
bordatella
none
Are vaccinations current?
yes
no
Has the dog been tested for heartworm?
yes
no
If yes, what were test results
Is the dog taking heartworm preventative?
yes
no
If yes, when is the next dosage due?
Is the dog microchipped?
yes
no
Check if the dog has ever shown any of the following behaviors when handled by a vet or groomer.
Rows
never done
shows teeth/growls
snap
bite
none of these
examine
restrain
administer shots
bathe
clean ears
trim nails
take blood
Does the dog have to be muzzled at the veterinarians?
yes
no
Does the dog have any past or present health problems?
yes
no
If yes, please describe
Is the dog currently taking any medication?
yes
no
If yes, please list medications
FEEDING
What type of food does the dog eat?
canned
dry
soft
table scraps
raw
home cooked
How many times a day is dog fed?
1 time
2 times
3 times
free feeds
How much is fed per feeding?
1 cup
1 1/2 cup
2 cups
2 1/2 cups
not sure, just fill the bowl up
Other
Does the dog get treats?
yes
no
If yes, what treats does the dog like?
OTHER
Please feel free to tell us any other information about the dog you feel is important.
Please upload a full body picture of the dog
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Please upload a up close head shot of the dog
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Please upload any records you have for the dog
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