Owner Surrender Form
Email *
Full Name (First/middle initial/last) *
Street Address *
Street Address *
City, State and Zip *
Phone Number (Cell) *
Phone Number (Home)
Dog's Name/breed/size/gender/age *
Is this dog crate trained? *
On average how long is your dog in his/her crate?
How many times a week is your dog crated?
Is your dog crated while you are at home?
How does your dog behave in his/her crate?
Is this dog potty trained? *
Please describe the dogs energy level: *
Does this dog experience any of the following behaviors:
Please explain in detail:
What is the reason for surrendering *
What steps have you taken to correct the behavior? *
Has this dog had professional training? If so, please explain? *
How soon will you need placement of this dog? *
How did this dog come into your care? *
Is this dog up-to-date on vaccines? *
Is this dog spayed/neutured? *
What is the primary vet for your dog? Please include phone number. *
What owner name is the pet under at the vet clinic? *
Does this dog get along with the following? *
Please include anything else you would like us to know about this dog *
I understand it is a requirement for my dog to meet a foster family and their resident pets to make sure it is a good environment for everyone. *
Please e-mail photos or videos of your dog interacting with people/kids/dogs if possible.
Please understand that we may not be able to help this particular dog. We are completely foster based and if we don't have a open/willing foster home we will not be able to help. We try to help every dog but sometimes cannot. *
Date *
Electronic Signature *
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