Owner Surrender

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

Country

*State/Province

My dog

Please be as detailed and accurate as you can:

What is the dog's name, gender, age, and breed?

My dogs is good with:

other dogssmall childrenolder childrenmenwomencatssmall critters like squirrels

Behavioral issues

aggression towards humansleash reactivitybarkingresource guardingseparation anxietyjumping up to peopleaggression towards other dogs

Medical issues

What is the dog's energy level?

hypervery activeactivemellowcouch potato

what kind of food do you give your dog, which brand?

Has your dog stayed with others or has been to doggy day care?

How many hours is the dog usually alone during the day?

rarely1 to 2 hours3 to 5 hours5 to 10 hours

where does the dog usually sleep

is the dog an outside only dog?

YesNo

Medical History

Weight of the dog

5 to 20 lbs20 to 40 lbs40 to 60 lbs60 to 80 lbsover 80 lbs

vaccinations

up to date on Rabiesup to date on Distemperup to date on Bordatella

Spayed or Neutered

YesNo

chipped

YesNo

Dog History

Has the dog ever been picked up by animal control? If yes, please explain

Has the dog ever escaped from your yard? If yes, please explain

Has the dog ever nipped or bitten anyone? If yes, please explain

How does the dog act around strangers?

Does your dog play with other dogs? Please explain.

What kind of training have you done with your dog

Why are you giving up your dog? *

What other medical issues does the dog have that we should know about? Please explain.

How soon does your dog need to leave your home? *

within a weekwithin a monthas soon as possible

where did you obtain the dog and for how long have you had the dog?

Photos, Videos, and documents:

Please send up to 6 high resolution current photos/videos of your family, pets, house, backyard, fences, pool, etc. or relevant documents. A short video would be great if possible too.
Please use doc, docx, rtf, csv, xls, xlsx, jpg, jpeg, gif, png, ppt, txt, pdf, mp4, mov, wmv, avi, flv, webm, mpeg-2. HEIC extension is not accepted for now.

Large files with very slow upload speed may fail.

Please upload video or photo:

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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