Surrender a Dogue Form

Full Name*
FirstLast
Address*
Street AddressCityStateZIP Code
Home Phone:*
Cell Phone
Other
Email*
Please provide the following information:
DOG 1:
Name Breeder Age
Gender
- Male
- Female
Spayed / Neutered?
- Yes
- No
House trained?
- Yes
- No
Crate trained?
- Yes
- No
Leash trained?
- Yes
- No
Good w/kids?
- Yes
- No
DOG 2:
Name Breeder Age
Gender
- Male
- Female
Spayed / Neutered?
- Yes
- No
House trained?
- Yes
- No
Crate trained?
- Yes
- No
Leash trained?
- Yes
- No
Good w/kids?
- Yes
- No
DOG 3:
Name Breeder Age
Gender
- Male
- Female
Spayed / Neutered?
- Yes
- No
House trained?
- Yes
- No
Crate trained?
- Yes
- No
Leash trained?
- Yes
- No
Good w/kids?
- Yes
- No
Please provide the following information:
Has the Dog(s) shown human aggression (bit someone, attempted to bite)? If yes, explain.
Please describe the dog(s) general temperament.
Has the dog(s) shown animal aggression? If yes, list circumstances.
Does the dog(s) have any medical issues?
Why do you have to give up your dog(s)?
Any additional info you think will help us determine if we can take this dog(s) into the rescue program?
Would you be willing to provide a donation to help care for the dog?
- Yes
- No
Please provide the contact information for your veterinarian:
Company Name:
Veterinarian's name:
Address
Street AddressCityState / Province / RegionZIP / Postal CodeCountry
Phone
Fax
Upload a Picture
Attach one picture of the dogue you would like to surrender. Keep picture size to 2 MB.
Please verify that you own the image that was uploaded.
- I own all rights to the image. I can prove that the image is available for public use, i.e. free of all copyrights.
*
Signed: Date:

To digitally sign this document, please type in your first and last name in the space provided.

Surrender a Dogue Form

Please provide the following information:

Please provide the following information:

Please provide the contact information for your veterinarian: