Owner Surrender Form

  • Owner Surrender Form

    Release of Said Animal to Texas OES Rescue, Inc
  • Date*
     - -
  •  -
  •  -
  • Children

  • About the dog

    Basic information about the dog. Breeder, feeding and grooming details.
  •  -
  • What is the sex of the dog?
  • Are they spayed/neutered?
  • Last Groomed?
     - -
  •  -
  • Does dog need to be groomed?
  • If yes, is the dog matted?

  • Does the dog need a bath?

  • Is the dog house broken?

  • Previous Owner

    Any information about the previous owner will be appreciated, enter below:
  •  -
  •  -
  • Children
  •  -

  • Training

    Commands dog responds to:

  • Please answer either (always - sometimes - never)

  • Sit
  • Come
  • Down
  • Stay
  • Is dog leash trained?
  •    
  • Is your yard fenced?

  • Is dog allowed to run loose?

  • On leash at all times?

  • Can you take the dog for a walk off leash?

  • Health History

  • Do you have all medical records with you? *

  •  -
  • Rabies Tag Date
     - -
  • Distemper Date
     - -
  • Hepatitis Date
     - -
  • Parainfluenza Date
     - -
  • Leptospirosis Date
     - -
  • Bordetella Tag Date
     - -
  • Coronavirus Date
     - -
  • Fecal Date
     - -
  • Heart-worm Date Tested
     - -
  • Heartworm last given
     - -
  • Heart-worm type
     - -

  • Typical day for dog.

    Please list what the dog is doing and with whom during the following times:
  • Has dog been crate trained?

  • When left alone inside, is dog:

  • Temperament

  • Please answer all that best describe the dog:

  • Characteristics and Peculiarities

    The following is a list of dog behavior problems. Please list either (always - sometimes - never). If always or sometimes, please describe (when, where, why, etc.)

  • Signatures and Comments

    How soon must you, or how desperate are you to give up the dog? Would you be willing to keep the dog until it is placed?

  • Placement

    Before this dog can be placed in a new home, he or she must be groomed, updated on inoculations and have a current heart-worm test. We also recommend that the dog be altered. If the owner is unable to do these things, we ask for a donation to help cover these expenses. We realize that every situation is different and our main concern is the welfare of the dog. Thank you for your cooperation. I, (owner of said dog), have read, understood, and answered all of the above questions completely and honestly, making no misrepresentations concerning the temperament, health or behavior of the above named dog.
  • Date
     - -
  • Should be Empty: