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Dog Information Form
Please fill this form out completely. The more information we have about your dog, the easier it is for us to find the best home. Thank you!
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Dog's Name and Age *
Breed/Color *
Sex *
Is Your Dog Fixed? *
Owner's Name: *
Phone #: *
Address: *
City/State/Zip: *
Why are you surrendering the dog? *
How long have you owned the dog? *
Where did you get the dog? *
Please list any vet with records for this dog (if any): *
Any known medical conditions/major medical concerns: *
Has this dog EVER shown aggression (growling, snapping, showing teeth, etc) toward people or other animals? *
If you answered yes to above, please explain:
Has this dog ever bitten anyone? If yes, please explain *
Has this dog lived with: *
Required
Was the dog good with those listed above? *
This dog is an: *
Is this dog potty trained? *
Is this dog crate trained? *
How does the dog behave when left home alone? Any destructive behaviors? *
If you could describe the best type of home for your dog, what would it be? *
Does your dog have any favorite types of toys, activities (ie swimming, fetch, etc)? *
By entering your name below, you are swearing that you are the legal owner of the animal you are relinquishing to CCHS or that you have permission from the owner to surrender the animal. You understand that by signing this form, you are giving up all legal rights to this dog at this time. You are also swearing that the information you have provided is true to the best of your knowledge. Please enter your name and the date below. *
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