Petstablished | Manage your Animal Welfare Organization (AWO) with our easy-to-use software.

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* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

* GenderMaleFemale

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Please tell us why you are rehoming your dog?

We need to have a detailed reason.

Dog's Name

Date you acquired your dog?

Approximate age of your dog?

Dog's sex?

FemaleMale

Breed or breeds of your dog?

Please indicate if your dog is a mixed breed, list all breeds.

Dog's approximate weight?

Is your dog spayed or neutered?

YesNo

Is your dog microchipped?

YesNo

Microchip number?

Please list all current medical conditions.

If none, please indicate none.

Please list all current medications.

If none, please indicate none.

Are your dogs vaccinations up to date?

YesNo

Is your dog housebroken?

YesNoMostlyHas an occasional accidentMy dog pees freely wherever

Does your dog display or demonstrate ANY types of aggressive behaviors?

Please be honest with us!

YesNo

Please explain aggressive behaviors.

If none, please indicate none.

Is your dog good with...

Check all that your dog is good with. Leave blank if unsure or not good with.

Cats Other dogsMenWomenChildren over the age of 5 years

How well does your dog walk on leash?

Very GoodGoodOkayPoorlyIt's a real struggleI have road rash from being dragged

Grade your dog's degree of separation anxiety from humans.

"1" being no anxiety and "10" being extreme anxiety.

Please tell how well your dog travels in a car.

Please tell us the type of home your dog is best suited for?

You know your dog best and Mutts Up wants to find your dog the best environment possible.

Do you agree to a home visit from a Mutts Up representative?

YesNo

Do you acknowledge that there will be a surrender fee to be paid at the time you surrender your dog to Mutts Up?

Fees are established during a phone interview.

YesNo

Please upload a current picture of your dog.

Applications received without a current picture will not be processed.

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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Owner Surrender Application

Personal Information

Please Tell Us About Your Dog

Picture of Your Dog