Owner Surrender Request Form
All owners wishing to relinquish their dogs to The Bullpen must fill out this form. In addition to answering the questions below, we encourage owners to provide us with any and all information that may be helpful to the rehabilitation and rehoming process. Once this form is received, someone from our team will be in touch to discuss the specifics and a timeline for the surrender.

The Bullpen ONLY accepts the following:
1. Purebred giant breed dogs
2. Mixed-breed dogs weighing more than 100lbs (when fully grown)
3. Purebred Bulldogs (English, American, French)

Please be aware that the rescue is currently at maximum capacity and that submitting this form only guarantees your dog a spot on our waiting list. We do our best to expedite the intake process, but depending on the urgency of the surrender, the specific needs of your dog, the number of open foster homes, and studio availability at the sanctuary, it may be days, weeks, or occasionally longer before we are able to accept your dog into the program.


OWNER INFORMATION
Today's date
MM
/
DD
/
YYYY
Your first name
Your answer
Your last name
Your answer
Street address
Your answer
City
Your answer
State
Your answer
Email address
Your answer
Primary phone
Your answer
Secondary phone
Your answer
Best time of day to reach you
Your answer
Reason for surrender
Your answer
Please indicate the urgency of this surrender:
DOG INFORMATION
Dog's name
Your answer
Approximate age of dog
Your answer
Breed
Your answer
Sex
Your answer
Color
Your answer
Is your dog spayed or neutered?
Does your dog have a current rabies vaccine?
If yes, please provide the rabies tag number. If not, write N/A
Your answer
Does your dog have a microchip?
If yes, please provide the microchip number. If not, write N/A
Your answer
ORIGIN OF DOG
How did you come to own this dog?
Your answer
If purchased from a breeder, please provide the breeder's name, address, contact information, and approximate date of purchase.
Your answer
How long have you owned or been in possession of this dog?
Your answer
TEMPERAMENT
Please describe the dog's general temperament.
Your answer
Please describe the dog's energy level.
Couch potato
Bouncing off the walls
Please provide any additional information related to your previous answer.
Your answer
CURRENT ENVIRONMENT
List all members of your family that the dog has regular interaction with, including their relationship to you and their age.
Your answer
List all pets and/or animals that you own, or that this dog has regular contact with.
Your answer
If applicable, please describe the interactions between the dog and your other animals. Are they friendly, playful, dominant, aggressive etc.?
Your answer
Does your dog live indoors or outdoors?
Your answer
REACTIONS & RESPONSES
Please check the box(es) that best describes the dog's previous interaction with the following groups and note any additional information you wish to provide in the space after the "other" box
Men
Required
Women
Required
Children <10
Required
Children >10
Required
Cats
Required
Small dogs
Required
Large dogs
Required
What does your dog like to do?
Your answer
What does your dog NOT like to do?
Your answer
Is your dog afraid of anything?
Your answer
TRAINING & BEHAVIORS
Is your dog housebroken?
Please rate the level of housebreaking:
Not at all housebroken
Completely housebroken
Is your dog crate trained?
Please rate the level of crate training:
Dog has never been inside a crate
Dog will go into crate voluntarily/on command
Is your dog leash trained?
Please rate the level of leash training:
Dog is not manageable on a leash
Dog walks calmly beside owner on leash
Is your dog obedience trained?
Please rate the level of obedience training:
Dog does not know any commands
Dog responds to basic or advanced commands
Please note any additional information related to the dog's training that you wish to provide.
Your answer
Please indicate the frequency that your dog exhibits any of the following behaviors:
Never
Rarely
Occasionally
Usually
Daily
Jumping
Chewing
Marking
Digging
Mouthing
Excessive barking
Are there any other behaviors that you think we should be aware of? If so, please note them below and indicate how frequently they occur.
Your answer
AGGRESSION & BITE HISTORY
Has your dog ever seriously injured or killed another animal?
If yes, please provide a detailed account of the event. If the dog has injured or killed more than one animal, please include an entry for each incident.
Your answer
Has your dog ever acted aggressively (including growling, snarling, lip curling, etc.) towards a person?
If yes, please provide a detailed account of the aggression. If the dog has acted aggressively towards more than one person, please include an entry for each incident.
Your answer
Has your dog ever bitten a person?
If yes, please provide a detailed account of the bite. If the dog has bitten more than one person, please include an entry for each incident.
Your answer
MEDICAL HISTORY
Is your dog current on annual vaccinations?
Approximately when was the last time your dog was vaccinated?
Your answer
When was the last time your dog had a heartworm test?
Your answer
What were the results of the last heartworm test?
Is your dog currently on heartworm preventative?
If yes, what type of heartworm preventative are you using and when was it last given?
Your answer
If your dog is NOT currently on heartworm preventative, when was the last time it was given?
Your answer
Is your dog currently on flea and tick preventative?
If yes, what type of flea/tick preventative are you using and when was it last given?
Your answer
Has your dog ever been given medication for intestinal worms (dewormed)?
If yes, when?
Your answer
Please provide a detailed account of the dog's medical history, including an entry for each condition, when it was first detected, and any treatment provided.
Your answer
Please list the clinic name, city and state, and contact information for any veterinarians who have ever examined or treated your dog. Include the approximate date(s) that your dog was seen by the veterinarian(s).
Your answer
By typing your name below, you hereby agree that you have answered the questions to the best of your knowledge and have not knowingly submitted false or misleading responses.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of The Bullpen Way Station and Sanctuary, Ltd. Report Abuse - Terms of Service - Additional Terms