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Surrender Application
Dog's Sex
Male
Female
Spayed/Neutered
Yes
No
Why are you surrendering this dog?
Would you recommend placing this dog in a home with young children?
If this dog has lived with young children, how did they interact? (Check all that apply)
Please tell us what other animals this dog has lived with. (Check all that apply)
What has been this dog's experience with other dogs in your home or outside of your home? (Check all that apply)
Would you recommend placing this dog in a home with other dogs?
Yes!
No!
Not Sure
Please explain: __________________________________________________________________
What has been your experience with any opportunities this dog has had to interact with cats? (Check all that apply)
Would you recommend placing this dog in a home with cats?
Yes!
No!
Not Sure
Please explain: __________________________________________________________________
When this dog is inside, he/she is:
When this dog is outside, how is he/she confined:
Is this dog house trained?
Yes
No
Is this dog crate trained?
Yes
No
What type of food does this dog eat?
Which behaviors is this dog familiar with? (Check all that apply)
Leash walking behavior (Check all that apply)
Has this dog had obedience training?
Yes
No
What type of training? __________________________________________________________________
How do you discipline this dog?
Does this dog play with other dogs?
Does this dog have any behavior issues that a new adopter should be aware of? (Check all that apply)
Is this dog scared of (Check all that apply)
Has this dog ever bitten or snapped at an individual?
Yes
No
If yes, please explain: _______________________________
If there is a bite history, when did the bite occur? _________________________________
How would you characterize this dog overall? (Check all that apply)
Current on vaccinations?
Yes
No
Has Heartworms?
Yes
No
Unsure
In the last 30 days, has this dog had (Check all that apply)
In the last 30 days, has this dog been to a boarding facility or doggy daycare?
Yes
No
Does this dog have any current, previous, or recurring medical problems?
Yes
No
If yes, please explain: _______________________________

Owner Information:

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