Owner Surrender Application

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Personal Information

Dog Information

This is called resource guarding.
Type of containment is your dog used to when outside. Multiple options may be selected.
Does your dog bark, growl, hide or try to bite the object when hearing or seeing these objects.

Medical/Health Questions

If not on heartworm preventative, please say "not taking any"
Please list names of medication and how often
By initially gives us permission to obtain medical records for this dog.

Surrender's signature



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