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Name of Pug
Age of Pug
Sex of Pug
Is the Pug spayed or neutered?
Color of Pug
Why are you surrendering this Pug?
How long have you owned this Pug?
Where did you obtain this Pug?
Is there a timeframe which the Pug needs to be moved out of your home?
Housetraining:
Where is the Pug kept during the day?
Where is the Pug kept at night?
Where is the Pug kept when nobody is home?
The Pug has lived in the same household with:
Please describe your Pug's behavior and habits (check all that apply):
Does your Pug have a history of biting?
If Yes, please explain:
Has your Pug ever fought with another dog?
Is your Pug microchipped?
If Yes, what is the microchip number/brand?
Pug's favorite toys:
Commands the Pug understands:
The Pug's diet is:
Dog food brand(s):
The Pug is given a heartworm preventative:
Date of last vaccinations:
Vet/Clinic Name:
Vet/Clinic Phone Number:
Please list any injuries or illnesses that the new guardian of this Pug should be aware of:
Is there anything else you would like to tell us about this Pug (Additional Information Area)?
You MUST attach a photo of your Pug for your surrender form to be submitted. If you are having difficulty attaching a photo or with any part of this application please contact secretary@bluegrasspugrescue.org
Upon submission of the Bluegrass Pug Rescue, Inc. Surrender Form, I hereby certify that I am the rightful owner/custodian of the pug(s)/pug mix(es) who is/are the subject of this Surrender Form, hereinafter referred to as “the pug”. I hereby surrender any and all property rights to the pug and certify that no other person has a right of property or any other claim to the pug. I understand that once I relinquish the pug, the pug will not be available to be returned to me. I further certify that I have read and understand the terms of the Surrender Form.
Agreement to Surrender
Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.