Owner Surrender Form

Dog's Name

Male or Female

Age / Date of Birth

Color

Ears (Cropped or Natural)

Please indicate the following information:

Tail

Where did you get your dog?

How long have you had your dog?

Why are you rehoming your dog?

Has your dog received vet care in the last 12 months?

List the Vets name, address and phone number.

Is your dog current on vaccinations?

What vaccinations has your dog had?

Is your dog on heartworm prevention?

Has your dog had a heartworm test?

If yes, is your dog heartworm positive?

Is the dog spayed or neutered?

Has your dog had a fecal exam for parasites?

Does your dog have any medical issues?

List any medications your dog is taking.

Which of the following best describes your dog? (Check all that apply)

Are there any behavioral problems?

What other animals does your dog get along with? (Check all that apply)

Does your dog get along with children?

Are there children in your home?

If yes, how many and how old?

Has your dog ever shown signs of aggression toward people?

If yes or somewhat, please describe the details.

Is your dog house trained?

Is your dog crate trained?

What type of food does your dog eat? (Check all that apply)

What brand of food does your dog eat? How much and how often?

Are there any specific feeding instructions you wish to share with the new owner?

Where does your dog sleep at night?

Where does your dog stay during the day?

How does your dog react to being left alone?

Is your dog allowed on the furniture?

Is your dog afraid of anything in particular? Please be as detailed as possible.

Does your dog like riding in the car?

Does your dog jump kiddie gates or backyard fences? If yes, describe below.

What is your dogs favorite toy, play thing or favorite pastime?

What does your dog like?

What does your dog dislike?

Is your dog a digger?

Describe any training your dog has had.

Is there anything else you can share that is special, unusual, or endearing about your dog that would be helpful to the new owner?

Agreement
When surrendering the dog please bring the following items if you have them:
Toys, bowls, crate, blankets, beds, food and any other items you may have so it will make it easier for the dog to adjust to his/her new home. In addition, we request a MONETARY donation of $50 to 100 to go toward the food and veterinary care for your dog.

Owner Signature waiver: I agree that by typing my name below, that I have read and understood the conditions of the Ownership Surrender Release Contract. Furthermore I agree to abide by the terms of the Ownership Surrender Release Contract.

Date