Surrender Application | Trogers Trd Rescue A

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Trogers TRD Rescue at Dragonfly Farms

A 501(c)(3) Nonprofit Organization

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Surrender Application

First name*

Last name*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Phone*

Email*

Name of Dog / What does he/she respond to?*

Age of dog (DOB or Approximate, if unknown)*

How long have you had this dog?*

Dogs gender*

Male

Female

Spayed/Neutered*

Yes

No

Unknown

Microchipped*

Yes

No

Unknown

Microchip #

Approximate weight*

Why are you surrendering this dog?*

Moving

Allergies

Not House Trained

New Baby

Too Much Energy

No Time

New Job

Other - See options below

Not getting along with other pets or family members (please explain):

Behavior issues (please explain):

Other reason (please explain):

How did you obtain this dog? If a breeder, provide breeder name and contact information:*

Would you recommend placing this dog in a home with young children?*

Yes

No

Not Sure - Include in the "Get to know me"

If this dog has lived with young children, how did they interact? (Check all that apply)*

Dog actively avoided children

Dog growled at children

Dog bites/nips at child(ren)

Children could pet the dog

Ignored each other

Played together

Gentle/Affectionate

Jumps on/Knocks over

Did not live with children

Other - Include in the "Get to know me"

Please tell us what other animals this dog has lived with. (Check all that apply)*

Male dog(s)

Female dog(s)

Cat(s)

Farm animals

Never lived with other animals

Other pet(s) - Include in the "Get to know me"

What has been this dog's experience with other dogs in your home or outside of your home? (Check all that apply)*

Bullies

Frightened of

Friendly/Playful

Ignores

Shy

Growls/Snaps

Curious

Lunges on leash

Never around other dogs

Unknown

Other - Include in the "Get to know me"

Would you recommend placing this dog in a home with other dogs?*

Yes

No

Not Sure - Include in the "Get to know me"

Would you recommend placing this dog in a home with cats?*

Yes

No

Not Sure - Include in the "Get to know me"

When this dog is inside supervised, he/she is:*

Allowed to roam freely

Confined to roam in a specific area / room

Secluded / In a crate

Other - Include in the "Get to know me"

When this dog is outside, how is he/she confined:*

Fenced yard

Kennel / Fenced dog run

Electric fence

No confinement / Free run

Tethered by a chain or cable

Garage

Other - Include in the "Get to know me"

Does this dog jump fences? If so, what type of fence and how high?*

Activity level (describe what this dog is used to):*

Is this dog house trained?*

Yes

No

Sometime has accidents

Unknown

Is this dog crate trained?*

Yes

No

Unknown

What does this dog eat? Explain the diet (i.e., dog food, special, raw, dog treats, etc.): Any food aggression issues?*

Has this dog had obedience training?*

Yes

No

Unknown

Leash walking behavior (Check all that apply)*

Pulls on leash

Walks politely on leash

No exposure to a leash

Does this dog know commands/words/dog tricks?*

What are some of this dog's favorite activities and/or favorite toys? *

Where does this dog sleep (i.e., dog bed, crate, couch, etc.)? *

Does this dog have any behavior issues that a new adopter should be aware of? (Check all that apply)*

High prey drive

Barking

Nipping

Needy

Anxiety

Destructive behavior

Jumping on people

Aggressive towards people outside of home

Aggressive towards other dogs OFF leash

Aggressive towards other dogs ON leash

Aggressive towards visitors to home

Aggressive towards other animals

Other - Include in the "Get to know me"

Is this dog scared of (Check all that apply)*

Men

Women

Children

Strangers

Thunder

Fireworks

Vet

Groomer

Riding in the car

Bathing

Loud noises

Brushing

Nail clipping

Other - Include in the "Get to know me"

Has this dog ever bitten or snapped at an individual?*

Yes

No

Unknown

Other - Include in the "Get to know me"

How would you characterize this dog overall? (Check all that apply)*

Calm

Excitable

Hyper

Cuddly

Confident

Outgoing

Stubborn

Smart

Shy

Fearful

Nervous

Dependent

Independent

Happy

Clingy

Protective of family

Protective of home

Easy going

Other - Include in the "Get to know me"

Name of Veterinarian or Clinic:*

Number*

Date of last visit:*

Is this dog current on vaccinations?*

Yes

No

Unknown

Has this dog had a recent heart worm antigen test?

Yes

No

Unknown

Does this dog have any current, previous, or recurring medical problems?*

Yes

No

Other - Include in the "Get to know me"

Please list any other information that you feel would be helpful for us or for a new owner. This will help us make the best possible match for a new family.

Would you be willing and able to make a donation to Trogers TRD Rescue to support this dog's care, such as spay/neuter or other medical needs? While not required, our rescue operates solely on donations, and every contribution makes a difference!*

By checking this box and submitting this application, I understand that Trogers TRD Rescue has the right to accept or deny my surrender application.

Owner Information:

Federal Tax ID: 99-2130200

Approved by the IRS as a public charity, we are qualified to receive tax-deductible bequests, devises, transfers, or gifts under IRS Sections 2055, 2106, or 2522.

© 2025 by Trogers TRD Rescue. All Rights Reserved.

315-870-6931

Info@trogerstrdrescue.org

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