Surrender a Bully

Surrendering My Dog

Please provide as much information as possible.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Dog’s Name
Sex of Dog
Breed of Dog
English Bulldog, Pitbull, Boxer, etc
Dog's Age
I have owned this dog since:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Crate Trained?
House Trained?
Walks Well on Leash
Current Weight of Dog (in lbs)
Reproductive State
Current Brand of Food
Reason for Surrender
Bitten?
Up to Date (select all that apply)?

Other
Date Heartworm Pill was Given.

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Vet Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vet Phone Number

Area CodePhone Number
Name on Vet Records
Health Concerns
Behavior Concerns
Good with? (select all that apply)
Please explain
Additional Information
Image(s) of Dog

Browse Files

Cancelof
Latest Vet Records

Browse Files

Cancelof
I understand that this information is truthful to the best of my knowledge and I am the lawful owner of this animal. I agree with this contract and the policies described above, and agree to their conditions. I agree to hold PBR, its officers, board members, agents, and volunteers harmless for any loss of, damage to, or injury to persons, animals, or property arising from or relating to the placement of this dog. Upon surrender, I understand that I lose all rights to said dog.

I also understand that I may need to be required to pay a surrender fee up to $50 if my dog is not UTD with vaccines, preventative, or is fixed.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Should be Empty:

Surrendering My Dog