Owner Surrender Form

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Personal Information

Information About Dog Being Surrendered

Please answer questions as best as you can. This will help us greatly with the transition for your dog.

07/01/2022
example: boston terrier, pug, etc..
example: breeder, friend or family member, craigslist
Given monthly, last given 07/01/2022
ex: Heartgard Plus or Interceptor or Simparica
include skin or ears etc...
example: Purina, Blue Buffalo, etc ...
example: 1/2 cup dry, or not measured free fed as much as he/she wants to eat
example: rawhides, Kong chew toys, balls, etc...
example: gated in the laundry room; or crate, or alone on the couch
example: loud noises, baths, etc...
example: dog shakes or pees on the floor
Sweet disposition, he/she is very loving

Photos & Pictures

The owner surrendering this dog understands that any photos, medical records, or information provided are now the property of Boston Terrier Rescue East Tennessee. We may use cute pictures and information supplied by the previous owner to help find a new foster or forever home for the pet surrendered. 

Please attach photos of your dog here.

Signature Needed

Please type out your name to serve as the electronic signature

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