Owner Surrender Form
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
DOG INFO
Name of Dog
*
Age of Dog
*
Date of Birth
Gender
*
Male
Female
Is the dog spayed/neutered?
*
Yes
No
How long have you owned this dog?
*
Where was the dog originally obtained? (Shelter, breeder, friend, etc.)
*
Microchip Number (If not chipped, write "none")
Does your dog have any health issues?
*
Yes
No
If yes, please explain
Does your dog require special care with regard to teeth, weight, eyes, ears, tail or other?
*
Yes
No
If yes, please explain.
Is the dog current with their shots (Rabies, DHLPP, Bortadella)?
*
Yes
No
I don't know
Where is the dog kept during the day?
*
Where is the dog kept at night?
*
How many hours a day is the dog alone?
*
What brand of dog food does your dog eat?
*
Please describe the ideal home for your bulldog.
*
Is your dog protective over food?
*
Yes, with humans
Yes, with other animals
No
Is your dog protective over toys?
*
Yes, with humans
Yes, with other animals
No
Is your dog housebroken
*
Yes
No
Other
What commands does your dog know?
Are there any training behaviors or problems?
*
Yes
No
If yes, please explain.
What other animals does your bulldog get along with?
*
Dogs
Cats
Others
I don't know
My bulldog does not like other animals
Are there currently any children in your household or ones that visit regularly
*
Yes
No
If yes, please describe the ages of the children and how the bulldog interacts with them.
VETERINARIAN INFO
Name of Vet
*
Vet Phone Number
*
Vet Address
*
GENERAL INFORMATION
Reason for rehoming your bulldog.
*
Has this dog bitten anyone in the past?
*
Yes
No
If yes, please explain.
Has this dog bitten another animal?
*
Yes
No
If yes, please explain
Please provide additional information about your dog's personality and what their ideal future home would be like. The more information you can share, the better able we are to assess the dog.
*
Please remember that rescue will incur costs (food, medication, kenneling, etc.) for providing care to your dog until they find a new home. You agree to make the following donation to help cover these costs. (Please type in dollar amount.)
*
Authorization: I hereby represent and warrant each of the following: (a) that I am the rightful owner/keeper/caretaker/custodian of the dog (b) that I have authority to convey, surrender and relinquish the dog, (c) that I am hereby willfully surrendering and releasing any and all of my property rights to the dog, (d) that no other person has a right of ownership or property to the dog, (e) that upon surrender the dog may not be returned to me. I have read and understand the terms of this Surrender From.
*
Continue
Continue
Should be Empty: