Dog Surrender Form

Dog's Name *
Breed/Breed Mix *
Age *
Weight
Sex - Male, Female *
Is your dog spayed/neutered? *
Current Vet the dog sees *
Date of last Rabies Vaccine
Is dog up to date on shots? *
Where did you acquire the dog? *
How old was dog when you acquired it? *
How long has dog lived with you? *
Reason for Surrendering? *
Please indicate all that apply - friendly, shy, fearful, playful, affectionate, aggressive, reactive: * Friendly, shy, independent, fearful, playful, affectionate, aloof, agressive, overly reactive
What is dog afraid of? *
Where is dog sensitive ?(feet, ears, etc) *
Where does dog spend most of time? *
Do you have a fence? or use a tie out? electric fence? *
How long is dog left alone during day? *
Do you take dog for leash walks? *
Is your dog crate trained? *
Is your dog housebroken? *
Is dog destructive in house, yard? *
What does dog do when stranger comes to house or approaches? *
What does dog do if someone approaches dog bowl? *
Has dog lived with children? if so what age? *
Is dog good with children?
Has dog evern snarled, growled or bitten? explain *
Has dog lived with other animals - dogs, cats, other? please specify *
Is dog good with other dogs? Cats? please specify *
Has your dog ever fought with or injured another animal? explain *
Is dog on medicine or special food? *
Owner Name *
Owner Email Address *
Owner Phone Number *