Apply to Surrender a Dog

First Name*

Last Name*

eMail Address*

eMail Address Confirm eMail Address

Street Address*

Suite or Unit Number

City*

State*

ZIP

Country

Phone*

History

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Dog Default Status: Submitted

Are you the legal owner of the dog?*

Yes

Please Explain*

Are you the only owner of the dog?*

Yes

Please Provide Other Owner's Name:

Other Owner's Phone #

When Did You Get The Dog? (approximate if necessary)

How Long Have You Had This Dog?

How Was The Dog Obtained?

Please Explain

Breeder's Name (if Known)

Have They Been Notified?

Yes

Why Not?

Owner of Dog's Sire (If Known)

Why Are You Giving Up The Dog?*

Please Explain

Please Explain The Behavior Issues

Please Explain The Health Issues

Please Explain Care Needed

How Many Homes Has This Dog Had?

Veterinarian Information

Do You Have a Veterinarian?

Yes

Name of Clinic

Name of Vet

Street Address

Suite or Unit Number

City

State

ZIP

Phone

Dog's Name*

Dog's Registered Name (If Purebred)

Dog's Registration Number (If Known)

Primary Breed*

Breed Name

Secondary Breed

Breed Name

Primary Color*

Which Color?*

Secondary Color

Which Color?*

Gender*

Male

Female

Dog's Date of Birth (estimate if not known)*

Weight

Energy Level*

Good With Kids?*

Good With Dogs?*

Please Explain*

Good With Cats?*

Good With Small Animals?

Good With Livestock?

Is Dog Trained?

Are There Any Special Needs?

Yes

What Special Needs?

Select All That Apply

Description of the Dog

Photos of The Dog

Drop files here or

Accepted file types: jpg, gif, png, jpeg, Max. file size: 1 MB, Max. files: 3.

Upload Photos of the Dog (minimum of 3 - include one head shot, one full body) and 750 Wide x 750 High in Pixels

Dog & People

Is Dog A One Person Dog?

Does Dog Like Men?

Please Explain*

Does Dog Like Women?

Please Explain*

Does Dog Prefer Men?

Please Explain*

Does Dog Prefer Women?

Please Explain*

Does Dog Jump On People?

Is Dog Friendly With Strangers?

Is Dog Good With Other Animals?

Is Dog Good With Kids?

Does Dog Like Kids Under 6?

Does Dog Like Kids 6-10?

Does Dog Like Kids Over 10?

Dog's Temperament

Select All That Apply

How Are Dog's Social Skills?

Select All That Apply

Training

Does Dog Know Basic Commands?

Select All That Apply

Is Dog Obedience Trained?

Is Dog House Trained?

Is Dog Crate Trained?

Is Dog Leash Trained?

How Does Dog React on Walks?

Select All That Apply

Does Dog Know How To Use A Doggie Door?

Does Dog Have Occasional Accidents?

Does Dog Tear/Chew Furniture Or Carpet?

Can Dog Be Left Uncrated?

Does Dog Dig?

Does Dog Know How To Swim?

Does Dog Jump Fences?

Does Dog Escape?

Does Dog Ride Well In The Car?

Barking

Does Dog Bark At Noises?

Does Dog Bark At Someone At The Door?

Does Dog Bark Excessively?

Fear & Agression

Does Dog Exhibit Submissive Behavior?

Please Describe*

Does Dog Exhibit Aggressive Behavior?

Please Describe*

Does Dog Guard Food?

Please Describe*

Does Dog Guard Other Resources (Toys, People, etc.)?

Please Describe*

Is Dog Shy?

Please Describe*

Is Dog Fearful Of Strange Noises/Storms?

Please Describe*

Has Dog Ever Bitten Anyone?*

Please Explain*

Has Dog Otherwise Attacked Anyone?*

Please Explain*

Has Dog Attacked Another Animal (Dog, Cat or Other)?*

Please Explain*

Is there anything else you would like to let us know about the dog's disposition?

History

Veterinarian Information

Eating

Sleeping

Grooming

Dog & People

Training

Barking

Fear & Agression

Medical: MicroChip Information

Medical: Medical Conditions

Medical: Status

Medical: Dental Conditions

Medical: Known Allergies

Medical: Medicines

Notes

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