Dog Surrender Form

Owner's First and Last Name: *

First NameLast Name

Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email *

example@example.com

Home Phone

Area CodePhone Number

Mobile Phone *

Area CodePhone Number

Dog's Name*

Reason for Surrender *

Is your dog male or female?*

Is your dog spayed or neutered?*

What color is your dog?*

What is the approximate age of your dog?*

If known, what is the date of birth of your dog?*

How much does your dog weigh?*

Where did you get your dog (rescue, breeder, etc)?*

What is the name and phone number of your vet?*

Is your dog up to date on vaccinations?*

Does your dog have any known medical issues? If so, please describe as thoroughly as possible (This will help us find the best foster placement.)*

Is your dog microchipped? If so, please type the microchip number if you know it.*

Please tell us about your dog's potty skills: fully housetrained, partially housetrained, potty pad trained, etc.*

Is your dog leashed trained?*

Is your dog crate trained?*

Is your dog obedience trained; knows basic commands such as sit and stay, etc.*

Please tell us if your dog is uncomfortable or dislikes people, (men or women) or children.*

Has your dog ever bitten anyone? If so, describe the situation as thoroughly as possible. We do take dogs with bite histories but need complete information .*

Does your dog become aggressive around food or toys?*

Does your dog have other behavioral issues it would be helpful for us to know when finding the right foster home?*

What kind of food does your dog eat, how much and how often?*

Where does your dog sleep at night?*

Does your dog travel well in the car or is she/he scared or nervous?*

Please email 3 photos of your dog to info@luvachinrescue.org along with this Surrender Questionnaire. Luv A Chin Rescue cannot accept a dog without a photo. Different angles of the dog's body and face are preferred to confirm that the dog is a Japanese Chin.

Thank you for taking the time to answer these questions. We understand that surrendering your dog or the dog of a relative can be difficult and emotional. We will get back to you as soon as possible.

The information provided in this application shall not be shared to anyone else and is kept confidential

Luv A Chin Rescue Dog Surrender Form