Surrender Form DOG

Answering these questions honestly will help to ensure that we are able to provide the correct care for your animal. Please help us to help your animal.

Animal Name
Microchip Number
Species	Bird Camel Cat Chicken Chinchilla Cockatiel Dog Donkey Dove Ferret Gerbil Goat Goldfish Goose Guinea Pig Hamster Hedgehog Horse Llama Mouse Owl Pig Pony Rabbit Rat Snake Terrapin Tortoise
Breed	Abyssinian Affenpinscher Afghan Hound African Grey Airedale Terrier Akbash Akita Alaskan Malamute Amazon American American Bulldog American Curl American Eskimo Dog American Fuzzy Lop American Sable American Shorthair American Staffordshire Terrier American Water Spaniel American Wirehair Anatolian Shepherd Angora Rabbit Appaloosa Appenzell Mountain Dog Applehead Siamese Arabian Australian Cattle Dog/Blue Heeler Australian Kelpie Australian Shepherd Australian Terrier Balinese Basenji Basset Hound Beagle Bearded Collie Beauceron Bedlington Terrier Belgian Hare Belgian Shepherd Dog Sheepdog Belgian Shepherd Laekenois Belgian Shepherd Malinois Belgian Shepherd Tervuren Bengal Bernese Mountain Dog Beveren Bichon Frise Birman Black and Tan Coonhound Black Labrador Retriever Black Mouth Cur Bloodhound Bluetick Coonhound Bobtail Bombay Border Collie Border Terrier Borzoi Boston Terrier Bouvier des Flanders Boxer Boykin Spaniel Briard Britannia Petite British Shorthair Brittany Spaniel Brotogeris Brussels Griffon Budgie/Budgerigar Bullmastiff Bull Terrier Bunny Rabbit Burmese Burmilla Caique Cairn Terrier Calico Californian Canaan Dog Canadian Hairless Canary Cane Corso Mastiff Carolina Dog Catahoula Leopard Dog Cattle Dog Cavalier King Charles Spaniel Champagne D'Argent Chartreux Checkered Giant Chesapeake Bay Retriever Chicken Chihuahua Chinchilla Chinchilla Chinchilla Chinese Crested Dog Chinese Foo Dog Chocolate Labrador Retriever Chow Chow Cinnamon Clumber Spaniel Clydesdale Cockapoo Cockatiel Cockatoo Cocker Spaniel Collie Conure Coonhound Corgi Cornish Rex Coton de Tulear Cow Creme D'Argent Cymric Dachshund Dalmatian Dandi Dinmont Terrier Devon Rex Doberman Pinscher Dogo Argentino Dogue de Bordeaux Domestic Long Hair Domestic Medium Hair Domestic Short Hair Donkey/Mule Dove Draft Duck Dutch Dutch Shepherd Dwarf Dwarf Eared Eclectus Egyptian Mau Emu English Bulldog English Cocker Spaniel English Coonhound English Lop English Pointer English Setter English Shepherd English Spot English Springer Spaniel English Toy Spaniel Entlebucher Eskimo Dog Exotic Shorthair Extra-Toes Cat (Hemingway Polydactyl) Ferret Field Spaniel Fila Brasileiro Finch Finnish Lapphund Finnish Spitz Fish Flat-coated Retriever Flemish Giant Florida White Foxhound Fox Terrier French Bulldog French-Lop Gaited Gecko Gerbil German Pinscher German Shepherd Dog German Shorthaired Pointer German Wirehaired Pointer Glen of Imaal Terrier Goat Golden Retriever Goose Gordon Setter Grade Great Dane Greater Swiss Mountain Dog Great Pyrenees Greyhound Guinea fowl Guinea Pig Hamster Harlequin Havana Havana Havanese Hedgehog Himalayan Himalayan Holland Lop Hotot Hound Hovawart Husky Ibizan Hound Iguana Illyrian Sheepdog Irish Setter Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Italian Spinone Jack Russell Terrier Japanese Bobtail Japanese Chin Javanese Jersey Wooly Jindo Kai Dog Kakariki Karelian Bear Dog Keeshond Kerry Blue Terrier Kishu Komondor Korat Kuvasz Kyi Leo Labrador Retriever Lakeland Terrier Lancashire Heeler Leonberger Lhasa Apso Lilac Lizard Llama Lop Eared Lory/Lorikeet Lovebird Lowchen Macaw Maine Coon Maltese Manchester Terrier Manx Maremma Sheepdog Mastiff McNab Miniature Pinscher Mini-Lop Mini Rex Missouri Foxtrotter Mixed Breed Morgan Mountain Cur Mountain Dog Mouse Munchkin Munsterlander Mustang Mynah Neapolitan Mastiff Netherland Dwarf Newfoundland Dog New Guinea Singing Dog New Zealand Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norwegian Forest Cat Norwegian Lundehund Norwich Terrier Nova Scotia Duck-Tolling Retriever Ocicat Old English Sheepdog Oriental Long Hair Oriental Short Hair Oriental Tabby Ostrich Otterhound Paint/Pinto Palomino Palomino Papillon Parakeet (Other) Parrotlet Parrot (Other) Paso Fino Patterdale Terrier (Fell Terrier) Peacock/Pea fowl Pekingese Percheron Persian Peruvian Inca Orchid Peruvian Paso Petit Basset Griffon Vendeen Pharaoh Hound Pheasant Pigeon Pig (Farm) Pionus Pit Bull Terrier Pixie-Bob Plott Hound Poicephalus/Senegal Pointer Polish Polish Lowland Sheepdog Pomeranian Pony Poodle Portugese Podengo Portuguese Water Dog Pot Bellied Prairie Dog Presa Canario Pug Puli Pumi Quaker Parakeet Quarterhorse Ragamuffin Ragdoll Rat Rat Terrier Redbone Coonhound Retriever Rex Rhea Rhinelander Rhodesian Ridgeback Ringneck/Psittacula Rosella Rottweiler Russian Blue Saddlebred Saint Bernard St. Bernard Saluki Samoyed Satin Schipperke Schnauzer Scottish Deerhound Scottish Fold Scottish Terrier Scottie Sealyham Terrier Selkirk Rex Setter Shar Pei Sheep Sheep Dog Shepherd Shetland Sheepdog Sheltie Shiba Inu Shih Tzu Siamese Siberian Siberian Husky Silky Terrier Silver Silver Fox Silver Marten Singapura Skunk Skye Terrier Sloughi Smooth Fox Terrier Snake Snowshoe Softbill (Other) Somali South Russian Ovcharka Spaniel Sphynx (hairless cat) Spitz Staffordshire Bull Terrier Standardbred Sugar Glider Swan Swedish Vallhund Tan Tennessee Walker Terrier Thai Ridgeback Thoroughbred Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Tiger Tonkinese Tosa Inu Toucan Toy Fox Terrier Treeing Walker Coonhound Turkey Turkish Angora Turkish Van Turtle Vietnamese Pot Bellied Vizsla Warmblood Weimaraner Welsh Corgi Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Westie Wheaten Terrier Whippet White German Shepherd Wire-haired Pointing Griffon Wirehaired Terrier Xoloitzcuintle/Mexican Hairless Yellow Labrador Retriever Yorkshire Terrier Yorkie
Sex	Male Female
Date of Birth
Brief Description
Has the animal lived with children?	NoYes
If so, please specify ages
If no, has the animal met children and what was his/her reaction?
What age groups were any children met?
Has the animal lived with dogs?	NoYes
If so, please specify age and sex
Has the animal lived with cats?	NoYes
If so, please specify age and sex
Do you own any animals other than cats or dogs?	NoYes
If so, please specify the species	Bird Camel Cat Chicken Chinchilla Cockatiel Dog Donkey Dove Ferret Gerbil Goat Goldfish Goose Guinea Pig Hamster Hedgehog Horse Llama Mouse Owl Pig Pony Rabbit Rat Snake Terrapin Tortoise
Is the animal used to men and women?
What is the animal's reaction if you approach it when it is feeding?
Please describe your animal's feeding regime - brands of food, scraps, dry or tinned, flavours, feeding times and quantities. Any dislikes?
Has the animal been neutered?	Not known Yes No
What commands does your animal obey? And what commands are used? For example, sit or sit down; lie or lie down etc.
Owner's reason for parting with animal
Where did you get the animal from initially?
Is the animal upto date with its annual vaccinations?	NoYes
Date of last vaccination
Is the animal housetrained?	NoYes
Does the animal travel well in cars?	NoYes
Do you leave the animal 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?
Will the animal give up toys when commanded to?	NoYes
Would you describe your animal as a gentle player or does he/she like "rough" play? Describe your animal's play activity, eg. favourite game, favourite toy, etc.
How does your animal react to grooming?
How does your animal behave at the vets?
How does your animal react when he/she has done something wrong? How do you "tell him off"?
Does the animal pull on the lead?	NoYes
Does your animal return when called whilst off the lead?	NoYes
Please provide pictures of your dog
Photo of dog
First name
Surname
Address
Postcode
Telephonenumber
Emailaddress
Person providing information	Owner Agent Inspector
Signature	Clear