3CLR - Owner Surrender Request
Owner Information
Name of Dog's Legal Owner
*
First Name
Last Name
Owner's Phone Number
*
-
Area Code
Phone Number
Owner's Email
*
example@example.com
City/State Where Dog Is Located
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Dog Information
Dog's Name
*
Dog's Age (in years or DOB)
*
Breed(s)
*
Color
*
Please attach good quality photos that show the dog's full body, head, etc.
*
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Is this dog spayed/neutered?
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Yes
No
Is this dog house trained?
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Yes
No
Is this dog crate trained?
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Yes, but cries/barks
Yes, is calm
No, destroys crate
No, never tried crating
Does the dog have a microchip?
*
Yes & Registered
Yes & Not Registered
Not chipped
Unknown
If the dog has a registered microchip, upon surrender it will be necessary to transfer this to 3rd Coast Labrador Rescue
Does this dog get along with strangers? Adults? Kids? Other Dogs? Cats? Please explain in detail.
*
Please provide information for this dog's veterinary care. If unknown or not given, please enter N/A.
*
Rows
Date
Date of last Rabies Vaccine
Date of last Distemper Vaccine
Date of last Lepto Vaccine
Date of last Bordetella Vaccine
Date of last Heartworm Test
Date of last Heartworm preventative
Date of last Flea/Tick Preventative
If your dog's last heartworm test is more than 12 months old OR they have not received monthly preventative it will be necessary to obtain a 4DX Heartworm test from your vet or at the time of surrender at one of the rescues vets. If surrendering at one of our vets, it will be necessary to transport and remain on site until test results are received. Are you willing to do this?
Please provide the veterinary clinic name(s) and phone number(s) that have records for this dog:
*
Where did you obtain your dog from? If from a breeder please attempt to contact them before proceeding.
*
Have you contacted the above person/organization/kennel to see if they will take their dog back?
*
Does your dog have any CURRENT health or medical issues? If yes, please explain in detail.
*
Does your dog have any PREVIOUS health or medical issues? If yes, please explain in detail.
*
Has the dog received any training?
*
Please Select
Basic obedience training w/trainer
Advanced training w/trainer
Behavioral training - in the home
Behavioral training - boarding school
Good Canine Citizen
Does your dog exhibit any anxiety?
*
Please Select
Yes, destroys crates but is fine if left out
Yes, dog is on medication and it is working
Yes, dog is sad and beside itself when left alone and would do better with people home
No, calm and no anxiety
Does your dog have any CURRENT behavioral or temperament issues? If yes, please explain in detail. For example when your dog is "naughty" what do they do? Or when do they growl or snip?
*
Does your dog have any PREVIOUS behavioral or temperament issues? If yes, please explain in detail. For example has your dog ever guarded food or toys?
*
Why is this dog being rehomed? Please explain in detail.
*
Surrender Information
Is someone other than the dog's legal owner filling out this form? If yes, please provide name:
First Name
Last Name
Is someone other than the dog's legal owner filling out this form? If yes, please provide phone number:
-
Area Code
Phone Number
Is someone other than the dog's legal owner filling out this form? If yes, please provide email address:
example@example.com
How long can the dog be kept until a foster home is secured?
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Are you or someone you know willing to help with transport if the foster home is a couple of hours away?
*
In an effort to prevent unnecessary work for our unpaid volunteers, have you already exhausted all avenues to rehome your dog with family, friends, neighbors, etc?
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Type a question
By signing this, I understand that I must be the legal owner of the dog and can provide proof via vet records or a local animal control officer. I understand 3rd Coast Labrador Retriever Rescue is not agreeing to take this dog into their possession, but is requesting additional information about the dog for which surrender is being requested.
*
Submit
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