info@nobordersbulldogrescue.org
214-235-6494
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Surrender Agreement
Surrender Personality Prolife
Name of Dog
*
Name of Dog
Sex
*
Male or Female
Color
*
Color of Dog
Age
*
Age of Dog
Markings
Unique markings on the dog
Weight
Weight of dog
Breed
*
AKC Registration
AKC Registration Info
Microchip # and Brand
Microchip # and Brand of Microchip
Vetrinarian of Record Name
:Name of Veterinarian
Veterinarian Phone Number
Vet Phone Number
Date of Last Vaccinations
Date of last set of vaccinations for dog
Heart Worm Tested and Date
Date of last heart worm test
Spayed/Neutered
Has the dog been spayed/Neutered
Please explain reason for surrendering this dog.
*
Owner's Name
*
Has the dog been spayed or neutered
Address
*
Street and Unit #, City, State, Zip
Phone Number
*
Phone Number
Email Address
*
Email Address
PERSONALITY PROFILE OF THE SURRENDERED DOG
This profile will be used to find the best foster/forever home for the dog. Please provide honest answers.
Is this dog a house dog?
When/how does it exercise?
Does the dog understand the words
No
Car / Ride
Walk
Is this dog
Leash trained
Obedience trained
Housebroken
Where does the dog sleep?
Describe sleeping conditions...does the dog sleep on your bed, in a crate, a dog bed, etc.
Does the dog have any favorite toys?
Does the dog have any special tricks?
Does the dog have any favorite games?
Does the dog know any special words?
What is the dog's favorite brand of dog food?
Wet or dry dog food?
How much food does the dog eat?
Example: one cup, one and one half cups, one can, etc.
How often does the dog eat?
Example: both morning and night, one time in the evening, etc.
Has this dog ever been kept on a chain or a runner?
Can the dog be trusted to stay in the house by his/herself?
Can the dog be trusted to stay within a fenced yard?
Does the dog like
Children
Cats
Male Dogs
Female Dogs
Other Animals
If yes, list other types of animals
If yes, list other types of animals
Check all that apply.
Does the dog do any of the following
Sleep on the bed
Climb on the furniture
Destroy/chew furniture
Dump Trash
Chew
Dig
Chase cars
Bark/Howl
Whine/Talk
React to uniforms
React to hats
Enjoy car rides
Accept being in a crate
Growl at strangers
Check all that apply.
Is this dog afraid of
Brooms and/or mops
Vacuum cleaners
Fireworks
Thunderstorms
Loud noises
Check all that apply.
Where was the dog obtained
Friend
Breeder
Pet store
Animal shelter
Received as a gift
Have you been the continuous owner of the dog?
Yes
No
If no, please explain
If no, please explain
HEALTH OF THE DOG
Please answer all questions.
Does the dog take vitamins? If so, please provide brand.
Is the dog currently taking any medication?
If yes, please provide the name of the medicine and reason for taking.
How is the medicine administered?
Has the dog had any surgeries in the past?
Yes
No
Unknown
If yes, please provide the type of surgery and when it was performed.
Does the dog have any
Skin issues
Eye issues
Hip/joint issues
Why are you surrendering this dog?
Family Issues
Medical issues
Financial issues
Aggression
Other
Other
Printed Name
*
Signature
Date
*
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