Your Name *
Your Best E-Mail *
Your Phone Number *
Dog’s Name *
Microchipped? * YesNo
Spayed/Neutered? * YesNo
Why Do You Want to Surrender (or Need Assistance with) Your Dog? *
Do You Adopt Your Dog, Purchase From a Breeder, or Other? * We Adopted This DogWe Purchased From a BreederWe Acquired Privately
If You Adopted, What Organization Did You Adopt From?
If You Adopted, Have You Contact This Organization re: Returning the Dog to Them? YesNo
What Did They Say?
What Kind of Food are You Feeding Your Dog? *
If Your Dog Has Any Known Allergies, Please List Them:
Does Your Dog Have Any Other Medical Issues or Physical Concerns?
Please List All Meds & Supplements Your Dog Takes, and the Reason for Each
Has Your Dog Ever Been Aggressive Towards (Growling, Lunging, Snapping) or Bitten a Person? If So, Explain: *
Has Your Dog Ever Been Aggressive Towards (Growling, Lunging, Snapping) or Bitten Another Dog? If So, Explain: *
Has Your Dog Ever Shown Possessive or Resource Guarding Behaviors Around Food or Toys? Explain: *
Has Your Dog Ever Been Cared For by Another Person Outside of Your Home (Pet Sitter, Boarding Facility, Etc)? *
If So, Did Your Dog Have Any Issues During the Time You Were Away?
Is Your Dog Housebroken? * YesNo
Can Your Dog Remain Calm in a Crate for at Least 4 Hours at a Time? * YesNo
What Commands Does Your Dog Know? *
What Commands Does Your Dog Listen To the First Time Asked? *
Is Your Dog Exercised Outside of Your Home or Yard Daily? * YesNo
What Kind of Activities Do You Do Together, and for How Long? *
What Kind of Collar, Leash, or Training Tools Do You Use on Walks and at Home? *
Does Your Dog Walk Respectfully at Your Side When on Leash? *
If Not, What Triggers Any Negative Behavior?
Can Your Dog Hold a Down & Stay Command (Down/Place/Spot/Bed, etc.) for More Than Ten Minutes? * YesNo
Does Your Dog Wait for Permission Before Going Through Thresholds, Getting on Furniture, or Demanding Attention from You? * YesNo
What is Your Dog’s Favorite Activity? *
What is Your Dog’s Least Favorite Activity? *
What Would Have to Change in Order for You to Feel that You Have the Ability to Keep Your Dog in Your Home? *
1 + 0 = ? Please prove that you are human by solving the equation *
YOUR NEXT STEP IS TO FILL OUT THIS MANDATORY FORM.
OWNER SURRENDER FORM
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