Owner Surrender Request
This is an application to surrender your dog to Mannered Mutts Rescue. Please be honest with responses. Not every foster home is right for every dog. Being honest with responses ensures the dog's success in foster care.

Submitting this form does not guarantee placement. A volunteer will contact the owner in 1-3 business days to discuss our current foster home availability and/or schedule a formal evaluation of your dog.
Owner's Name *
Owner's Phone Number *
Owner's Address *
Owner's E-mail Address *
Dog's Name *
Dog's Breed/Breed Mix *
Dog's Sex *
Dog's Coloring *
Dog's Birthdate *
MM
/
DD
/
YYYY
How long have you owned this dog? *
Is the dog spayed/neutered? *
Where did you get this dog? *
Why are you surrendering this dog? *
Including yourself, how many people does the dog live with in your household and what are their ages? *
What other animals does the dog live with? *
Required
If you answered "yes" to the previous question, please describe.
How does the dog usually behave toward people they know? *
Required
How does the dog usually behave toward unfamiliar people? *
Required
Does the dog react differently to men and women? *
If you answered yes to the previous question, please explain:
Does your dog react differently to children? *
If you answered yes to the previous question, please explain:
How does your dog react to animals it knows? *
Required
How does your dog react to animals it does not know? *
Required
How does your dog react to other dogs while on leash? *
Required
Would you describe your dog as dog-friendly? *
If you answered no to the previous question, please explain:
How does the dog usually react when an unfamiliar person approaches or enters the yard or house? *
Required
Does your dog chase or attempt to chase any of the following? *
Required
If you answered other to the previous question, please explain:
How does you dog react when you or another family member bathe your dog? *
Required
How does you dog react when you or another family member brush your dog? *
Required
How does you dog react when you or another family member trim the dog's nails? *
Required
How does you dog react when you or another family member brush your dog's teeth/touch your dog's mouth? *
Required
Do you take your dog outside to go to the bathroom? *
Please describe your dog's bathroom routine: *
Does your dog have accidents in the house? *
If you answered yes to the previous question, please specify how many times a day & the circumstances when it usually happens:
Where does your dog spend most of his/her time?: *
If you answered other to the previous question, please describe:
How long is your dog left alone, without people, per day?
Clear selection
When left alone, does your dog show any of the following behaviors?: *
Required
When you are home, does your dog show any of the following behaviors?: *
Required
When your dog plays, does he/she typically: *
Required
What toys does your dog like? If your dog does not like toys, write "none." *
What games does your dog like to play? *
Required
If you answered other to the previous question, please describe:
Is your dog scared of anything? *
If you answered "yes" to the previous question, please describe:
Does your dog have any bad habits? *
If you answered yes to the previous question, please describe:
Has the dog been allowed on furniture? *
Where does the dog normally sleep at night? *
Required
Please list the commands your dog knows: *
Has your dog ever attended obedience classes? *
Has your dog ever been walked on a leash? *
Does your dog have problems riding in the car? *
Can your dog climb/jump fences? *
Has your dog escaped your property within the last 6 months? *
If you answered yes to the previous question, please describe the circumstances:
Is there any reports of the dog ever inflicting a serious bite to a person? *
Has your dog ever attacked another dog resulting in severe injury or death? *
Has your dog ever attacked another domesticated animal species resulting in injury or death? *
If you answered yes to the previous question, please tell us what species:
Has your dog ever displayed aggression (snapped at or bitten) toward (excluding vets & groomers): *
If your dog has ever snapped at or bitten an adult, did the incident take place while breaking up a dog fight or when the dog was in severe pain? *
If your dog has ever snapped at or bitten a child, did the incident take place while breaking up a dog fight or when the dog was in severe pain? *
Please explain the circumstances of any snapping or biting that has ever occurred:
Has your dog ever displayed aggression towards men, women, and/or children over: *
Required
Has your dog been seen by a veterinarian? *
If you answered yes to the previous question, please specify the veterinarian’s name, contact information, and the person’s name that the dog is listed under: *
Is your dog up to date on any vaccines? *
If you answered " yes" to the previous question, please list which vaccines your dog has received: *
Has your dog ever shown aggression toward the veterinarian and/or groomer? *
If you answered "yes" to the previous question, please describe the circumstances:
Does your dog need to be muzzled at the veterinarian and/or groomer? *
Does the dog have present medical conditions?
Clear selection
If you answered yes to the previous question, please describe: *
Does your dog currently take any medications or have a special diet?: *
If you answered yes to the previous question, please describe:
What kind of food is the dog used to eating?
What brand of food is your dog used to eating?: *
Please feel free to leave us any additional information that you feel might be helpful for us to get to know the dog:
I understand that submitting a surrender form does not guarantee placement in Mannered Mutts Rescue. A volunteer will contact me in 1-3 business days to inform you of our current foster home availability and/or to schedule a formal evaluation for your dog. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy