Dog/Puppy Surrender Form
Name:
Phone Number:
E-mail Address:
Dog’s Name:
Dog’s Age:
Spayed/Neutered:
Breed/Mix:
Color:
Microchipped:
Microchip Number:
Are you first owner:
Do you know what happened with previous owner if your not first owner:
Where did you get this dog (Neighbor, pet store, breeder, newspaper, exc.):
Dogs approximate weight:
Dog’s gender:
Why are you surrendering this dog/puppy:
How long did you own dog/puppy:
Does this dog/puppy have any physical issues/allergies:
Last Rabies Vaccine Date:
4-in-1 Vaccine:
Brand of dog food eaten:
Daily amount of food eaten:
Good with strangers:
Good with children:
Good with dogs:
Good with cats:
List any bad habits:
Sleeps with you:
Crate trained:
Housebroke:
Allowed Indoors/Outdoors:
Urinates in the house:
Chews:
Digs:
Likes car rides:
Allowed on furniture:
Guard food or toys:
Bites:
What would be ideal home for the dog:
When/where was this dog/puppy found:
Does it live in or around your home or elsewhere:
Any information about who might own the dog:
Is there any evidence that the dog/puppy is suffering from any bites, wounds or other injuries:
I am surrendering this dog/puppy to Dana Smiths Foster Care:
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Signature Date
