Jersey Pits Rescue Inc. Surrender Application
Name:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
example@example.com
Phone Number:
-
Area Code
Phone Number
Please list the NAME / AGE / WEIGHT / GENDER of pet:
Reason for surrender request:
How long have you had your pet for?
Where did you get your pet from?
Please check off all that apply. My dog is:
Crate Trained
Housebroken
Leash Trained
Trained with basic commands
Kid friendly
Cat friendly
Dog friendly
Good in the car
Other
Please describe your dog's personality using as many details as possible:
Would you consider your dog to be more:
Submissive
Neutral
Dominant
What are your pet's likes and dislikes?
Does your dog have any medical issues that you are aware of?
Yes
No
If yes, please describe your dog's medical issues and how they are treated:
Is your dog spayed or neutered?
Yes
No
Is your dog vaccinated?
Yes
No
If yes, what vaccines does your dog have? Please include date of vaccination:
Does your pet currently live with children under the age of 18? Or has your dog ever lived with children?
Yes
No
If yes, please list the ages of the children in the house. Please describe how your dog interacts with the children in the house:
Does your pet currently live with other dogs? Or has your dog ever lived with other dogs?
Yes
No
If yes, please list the names, ages, genders and breeds of the other dogs. Please describe how your dog interacts with the other dogs in the house:
Does your pet currently live with cats? Or has your dog ever lived with cats?
Yes
No
If yes, please describe how your dog interacts with the cats in the home:
Has your dog ever bitten another animal or person?
Yes
No
If yes, please describe the nature and frequency of the bites:
Please describe how your dog reacts to new people entering your home:
Please describe how your dog reacts to other dogs while out on walks:
Has your dog ever growled or shown aggression towards anyone?
Yes
No
If yes, please describe what causes your dog to growl at someone or behave aggressively? (example: taking away toy, touching food, etc)
Are you able to email photos of your dog to jerseypitsrescue@gmail.com? If yes, please do so immediately after submitting this form. Pictures with people, kids, and other animals are preferred.
Yes
No
Submit
Should be Empty: