Dog Surrender Form

Owners First And Last Name *
Address *
City *
State *
Apartment #
Zip code *
Home Phone
Cell Phone *
Email Address *
Surrendering Dogs Name *
Approximate Age of Dog *
Breed Of Dog *
Color Of Dog *	Amber Black Black and Brindle Black and Brown Black and Tan Black and White Black Tortie Blue Blue Tortie Brindle Brindle and Black Brindle and White Brown Brown and Black Brown and White Chocolate Chocolate Tortie Cinnamon Cinnamon Tortoiseshell Cream Fawn Fawn Tortoiseshell Ginger Ginger and White Golden Green Grey Grey and White Light Amber Lilac Lilac Tortie Liver Liver and White Ruddy Seal Silver Sorrel Sorrel Tortoiseshell Tabby Tabby and White Tan Tan and Black Tan and White Tortie Tortie and White Tricolour Various White White and Black White and Brindle White and Brown White and Grey White and Liver White and Tabby White and Tan White and Torti Yellow and Grey
Approximate Weight *
Gender Of Dog *
Is the dog spayed/neutered? *	NoYes
Has the dog been to the vet in the past 12 months? *	NoYes
Do you have any vet records for the dog? *	NoYes
Has the dog ever bitten or showed aggression to anyone? *	NoYes
If yes, please explain
Does your dog have any medical issues or concerns? *
Has your dog been around children, cats, or other dogs? *	NoYes
If yes, Please explain their interactions with either children or other animals.
Why are you surrendering the dog? *
How long have you had the dog? *
Was the dog found as a stray? If so where was the dog found? *
Is your dog very anxious or have anxiety? *
Is your dog up to date on their Vaccines *	NoYes
Which Vaccines does your dog currently have? *
Name Of Current Vet
Number For Current Vet