Owner Surrender Form

Dog's Name

Male or Female

Age

Color

Ears (Cropped or Natural)

Tail

We are nearing capacity. Will you agree to hold your dog until other arrangements are made?

Where did you get your dog?

How long have you had your dog?

Why are you rehoming your dog?

Does your dog have a microchip? If yes, provide the chip information below.

Is your dog up to date on vaccinations?

What vaccinations has your dog had?

Is your dog on heartworm prevention?

Has your dog had a heartworm test? If yes, was it positive or negative?

Has your dog had a fecal exam for parasites?

Does your dog have any medical issues? If yes, give a short description.

List any medications your dog is taking.

List the Vet's name, address and phone number.

Is your dog spayed or neutered?

Does your dog have any disabilities [deafness, blindness, arthritis etc]? If yes, please explain below.

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

Are there any behavioral problems? If yes, please describe below.

Does your dog get along with other dogs? If no, explain below.

Does your dog get along with children? If no, explain below.

Are there children in your home? If yes, please list the ages below.

Has your dog ever lived with a cat? If yes, how did they get along? Explain below.

Has your dog ever shown signs of aggression toward people? If yes, describe in detail below.

Is your dog house trained?

Is your dog crate trained?

Describe any special training your dog has had.

What type of food does your dog eat? 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.

Is your dog a digger?

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

What does your dog like?

What does your dog dislike?

Is there any additional information we can share with the new owner? Please list anything special, unusual, unique or endearing about your dog.

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