Owner Surrender Form

Pet's Name / Nicknames:

Sex: Male Female Age:

Breed:

Is your dog spayed or neutered?

How long have you owned your dog?

Why are you surrendering your dog?

Is your dog destructive when left alone?

Is your dog house trained? Yes or No Is your dog crate trained?

What cues does your dog know, if any?

Has your dog had previous training?

What veterinary does your dog go to?

When was your dog last at the vet?

When was your dog last vaccinated?

Does your dog have any known health related issues?

If Yes please explain.

Has your dog been on Heartworm preventative?

If answered yes, what kind?

When was your dog last tested for Heartworms?

What was the test result?

When was it last given?

Does your dog currently live with children?

If yes, what ages?

Please describe your dog's experience with children:

To strangers?

To visitors in the home?

If you try to take away a toy or bone?

If you take your dog's food while eating?

If your dog is disturbed while sleeping?

Any additional comments:

Does your dog live with other dogs?

How many?

If Yes, What are the age/sex/breeds ?

Does your dog get along with other dogs?

If yes, please explain your dogs experience with other dogs:

If no, please explain:

Does your dog get along with other type animals?

Does your dog live with cats?

If yes, please explain your dog's behavior with cats:

Does your dog have behavior issues?

If yes, please explain:

Does your dog have any fears?

If yes, please list all:

Where did you get your dog?

How does your dog react: When being seen by a veterinarian?

When being groomed?

To having his/her nails trimmed?

Has your dog ever bitten anyone?

If yes, did it break skin?

Was a bite report filed?

Please explain the bite incident:

Please list a few things you like best about your dog:

Why do you think your dog would be a good candidate for adoption?

Does your dog have any food aggression?

If Yes explain.

Signature:

Today's Date: