Owner Surrender Form

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Personal Information

Thank you for trusting us to care for your dog.

Please answer questions as best as you can. We also ask that you call your vet and give them permission to send us a copy of your pet’s records. This will help us greatly with placing your dog in the right foster home for their needs and scheduling proper vetting as well as the overall ease of transition for your dog.

Dog's Primary Information & Physical Characteristics

Example: Boston Terrier, Pug, Bulldog, Frenchie, Mix, etc.
Example: Breeder, Friend or Family member, Craigslist, Stray/Found

Health Status / Characteristics

Example: Heartgard Plus, Interceptor, Simparica
Example: Given monthly, last given 07/01/2022
Please include any issues with skin, ears, vision (blind, limited), hearing (impaired, deaf), mobility, incontinence, etc.

Microchip Information

Behavior / Daily Life

Example: dog shakes or pees on the floor
Example: loud noises, bath time, nail trims
Example: gated in the laundry room, crated, or alone on the couch
Example: Purina, Blue Buffalo
Example: 1/2 cup dry, or not measured / free fed as much as he/she wants to eat
Example: rawhides, Kong chew toys, balls
Example: 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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