Surrender Form

Do you acknowledge that you must indefinitely foster the dog until it is adopted in a clean and safe environment

Do you understand that no alternative foster arrangements or backup facilities will be available for the dog.

Do you understand that a timeframe cannot be guaranteed for the adoption process; the duration may vary, potentially extending for several months, depending on factors such as the dog's adoptability, the socialization efforts you provide, and the quality of the photos and videos you submit.

Do you understand that you must be able to transport the dog to any appointments, meet and greets, etc and that we have no other alternatives arrangements available for transportation

Do you understand the dogs vetting will need to be updated if not already up-to-date. This includes core vaccinations, alter and a heartworm test. If up-to-date on vaccines, you will need to submit the official vet records and vaccinations must be sourced from a vet, not a feed store.

Animal Name:

Breed:

Color:

Age:

Sex:

Is the animal spayed or neutered:

Where did you get your pet / How did they come into your care?

If 'other' please explain:

How long has this pet been in your care?

To the best of your knowledge, has your pet bitten or punctured the skin of any person?

If yes, please explain:

To the best of your knowledge, has the dog shown any signs of aggression towards any person (growling, snapping) without biting?

If yes, please explain:

This pet has been kept:

Clinic Name:

Phone Number:

Heartworm Test:

If tested, how long ago was the last test?

Any current or special needs?

If yes, please explain:

Vaccinations:

Please list any known health issues or diagnoses

Is the dog currently on any medications?

If yes, please list all medications and their purpose (please include heartworm preventatives and flea medications)

Are there any mobility issues (e.g., limping, arthritis)?

If yes, please describe

Is the dog currently pregnant or nursing?

Can you transport the dog to all required appointments?

If the dog requires major medical care (e.g., costing between $500 and $1500), are you willing to organize a fundraiser (ex: social media campaign, garage sale, etc?)

Their general overall physical condition is

Do they have any of the following

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The animal's personality is generally:

Do you have other dogs living in the home?

If you have dogs in the home, has this dog met them? If so, please describe how you introduced them. Are they coexisting in the home or are they being kept separated?

This dog has does well with the following other dogs

How does the dog react when passing new dogs on a leash in public?

Has the dog ever shown any reactivity/aggression/anxiety behaviours toward any other dogs to your knowledge?

If yes, please explain

Are there cats living in the home with the dog?

Has the dog met cats indoors or outdoors?

If the dog has met cats, how does it act?

Comments:

Has the dog shown any reactivity/aggression/anxiety behaviours toward cats/small animals/other animals to your knowledge?

If yes, please explain

This dog has does well with the following other animals

Are there any kids living in the home?

To my knowledge, the dog has met kids aged:

Has the dog shown any reactivity/aggression/anxiety behaviours toward kids to your knowledge?

If yes, please explain

Describe how the dog acts about kids- please be specific

The dog has met and done well with

How does the dog act when it meets new people? Example- Hesitant, excited, aggressive, reactive, happy, neutral. Please be as descriptive as possible

If yes, explain

Extra information about the animal. Please check all that apply:

Has the dog shown any reactivity/aggression/anxiety behaviours toward adults to your knowledge?

How does the dog walk on a leash

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How is the dog in a crate

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Where does the dog sleep currently?

Where does the dog stay when you are not home?

Any food related reactivity/aggression noted?

If yes, please explain

Any toy related reactivity/aggression noted?

If yes, please explain

Any other fear/anxiety behaviours noted?

comments

Is the dog scared of anything? Example- Hesitant around men, loud children, garbage trucks, bicycles. Please be as descriptive as possible

Any other behaviours noted? (ex. counter surfing, digging, eating objects, marking, poop eating) If yes, please explain

Owner Name/ Electronic Signature

Date: