Application for Surrender

Lab Rescue of Greater Richmond
P.O. Box 1574, Midlothian, VA 23113-1574

Phone: (804) 417-7527

info@labrescue-richmond.com
Application for Surrender
Applicant's Information
Applicant's First Name: *
Applicant's Last Name: *
E-mail: *
Cell Number: *
Co-applicant / First Name:
Co- applicant / Last Name:
E-mail:
Cell Number:
Address *

Street Address

City State / Province

Postal / Zip Code
Dog's Information
Photo

Please send a clear photo of the dogs face and body
A picture of the dog must be attached in order for us to proceed. *
Dog's Name: *
Is the dog a pure bred Lab? *
If known, what is the breed mix of the dog?
Birthday, If Known

Month Day Year
Date
Age: *
Weight: *
Color: *
Sex: *
Is your dog Spayed or Neutered *
Yes, No
How long have you owned the dog? *
Where did you get the dog? *
Dog's Home Life
How many hours is the dog home alone on a typical work day? *
Where does your dog stay when you are not home? *

Inside, Free reign Inside Crated Baby Gated inside Outside Kennel/Pen outside
Comments:
Where does your dog stay at night? *

Inside, Free reign Inside/ Crated Baby Gated inside Outside Kennel/Pen outside
Comments:
Is the dog house trained? *

Yes No
Is your yard fenced? *

Yes No
If yes, will the dog jump over the fence.

Yes No
Comments on height and style of fence.
Are there other pets in the home? *
Please tell us about the other pets in the home and how this dog behaves around those pets.
What is the brand of dogfood used and feeding schedule? *
Your Dog's Personality and Training
The dog knows/displays the following *

Likes to fetch Likes to swim Likes car rides Jumps on people Nervous in the car Barker Good on leash Knows Down Pulls on leash Knows Sit Knows Come Knows Stay Social with People High Energy Low energy Food Motivated Prey Drive
Comments on any of the above *
Dog's Temperament *

Social / Friendly with Strangers (People) Nervous / Needs time to warm up Playful/Outgoing Calm and Relaxed Easily Distracted Shy/ Easily Frightened
Comments on any of the above *
Dog Friendliness *

Dog Friendly Friendly with small dogs Aggressive with small dogs Dog aggressive Reactive to other dogs
Please explain how your dog greets other dogs. *
Appropriately sniffs ,comes in fast, growls, lunges, barks, happy and comfortable, stiffens
Cat Friendliness *

Aggressive with cats Cat Friendly Unknown
Is the dog good with children? *

Yes No Unknown
Ages of children the dog has been exposed to
If children are in the home, do the children and dog interact together? Please explain how your dog reacts and interacts with children ( Dogs Body Language) If not good with children, please explain behavior with kids in detail.
Has the dog bitten a child or adult? *

Yes No
If Yes, Please Explain:
Does your dog display any resource guarding with the following. Resource guarding refers to a dog displaying behavior (growling, snapping, etc.) intended to convince other dogs or humans to stay away from a particular treasure or “resource.” The resource can be food, treats, toys, a place (a bed or favorite chair), or occasionally a person. *

Food Toys Crate Bed Humans Other Dogs
If Yes, Please Explain:
Any destructive behaviors? *
Dog's Health Information
Does your dog have any mobility concerns? If Yes, please explain. *
Stairs, wood floors,etc
Is the dog current on vaccines? *

Rabies Distemper/Parvo/lepto Bordetella Not current on vaccines
Is the dog currently on Heartworm preventative? *

Yes No
When was preventative last given?
Date of last Heartworm test:
Flea preventative? *

Yes No
When was preventative last given?
Is the dog Microchipped? *
If Microchipped, where is the chip registered and what is the Microchip Number?
General Health Comments *
Veterinary Information
Veterinarian Practice : *
Veterinarian Practice Phone Number: *
Veterinarian Address: *
If your dog is not up to date on Vaccines and/or Heartworm Test, are you able to get the dog up to date before surrendering?

Yes, I can get my dog up to date prior to surrendering. No, I am unable to financial afford veterinary care for my dog.
* You will need to give your veterinarian permission to speak with a LRGR volunteer.
I have spoken to my veterinarian and have given them permission to speak with Lab Rescue. *

Yes No
Reason for giving up the dog? *
Does the dog need to be removed immediately or are you able to foster the dog while we find a forever home? *

Remove as soon as possible Remove within a few weeks Can stay until forever home is found
If you have additional information to add to this form, please enter it here:
Will you be donating the dog's crate?
By submitting this electronic form, I acknowledge that all the information on this form is true and correct. I understand that any misrepresentation of fact may result in legal action by Lab Rescue. *

I Agree
Type a question
Should be Empty:

Lab Rescue of Greater Richmond

Application for Surrender

Applicant's Information

Dog's Information

Photo

Dog's Home Life

Your Dog's Personality and Training

Dog's Health Information

Veterinary Information