What County Do You Live In? *
Henderson
Van Zandt
Other
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Drivers License Number *
Drivers License-State *
Email Address *
Home Phone *
Cell Phone Number
Surrender to Foster? *
No Yes
Are you surrendering more than one animal? *
No Yes
If surrendering more than one, how many?
Sex *
Male
Female
If surrendering more than one, how many of each sex?
Approximate Age
If different ages, please describe
Breed
Dog's Name(s)
Has your dog been spayed or neutered? *
No
Yes
Is your dog up to date with its annual vaccinations? *
No Yes
Date of last vaccination *
Is your pet on heart worm preventative?
No Yes
Do you regularly use flea/tick preventative?
No Yes
Please provide your veterinarian's name and phone number *
Do you have your pet's shot records? If not, please get them from your vet prior to your appointment
No Yes
How does your pet behave at the vet's office?
How does your animal react to grooming?
Is your dog housetrained? *
No Yes
Is your dog crate/kennel trained?
No Yes
What commands does your dog obey. What commands are used? For example, sit or sit down; lie or lie down etc.
Is your dog leash trained?
No Yes
Does your animal return when called whilst off the lead?
No Yes
Will your dog give up toys or a bone when commanded to?
No Yes
How does your animal react when he/she has done something wrong? How do you "tell him off"?
Would you describe your dog as a gentle player or does he/she like "rough" play? Describe your animal's play activity, eg. favorite game, favorite toy, etc.
Does your dog travel well in vehicles?
No Yes
Has he/she lived with other dogs?
No Yes
If so, please specify age and sex
Has he/she lived with cats?
No Yes
If so, please specify age and sex
How does your dog react to cats?
If your dog has lived with animals other than cats and dogs, please describe.
Has the animal lived with children?
No Yes
Is your dog used to men and women? Does it have a strong preference for one or the other?
If so, please specify ages
What age groups were any children met?
If no, has the animal met children and what was his/her reaction?
Please describe your dog's feeding regime - brands of food, scraps, dry or canned, flavors, feeding times. Any dislikes?
What is your dog's reaction if you approach it when it is feeding?
Do you leave your dog alone for any period of time? If so, how long for and do you have concerns about them being on their own?
Has the animal ever been destructive in the house? Please describe
Where does the animal sleep?
I understand that not all animals are considered adoptable and that the Humane Society of Cedar Creek Lake will not release the final disposition of the animal(s) *
No Yes
I agree that the Humane Society of Cedar Creek Lake, including its Officers and employees will not be obligated to me in any way resulting from such disposition *
No Yes
I understand that pets who are surrendered by their owner may be immediately placed up for adoption. Those that are deemed, by HSCCL staff, as too ill or too aggressive may be humanely euthanized. *
No Yes
I certify that I am the owner of this animal(s). I have read and fully understand the terms above
No Yes
Owner's reason for parting with animal
Where did you get the animal from originally and how long have you had it?