Surrender

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Number*

Email Address*

Pet name of dog*

Breed*

Date of birth*

Coat Colour*

Sex*

Tattoo/Microchip details*

Is the dog neutered*

What is the date of their last vaccination?*

When were they last treated against fleas?*

When we re they last treated against intestinal worms?*

When were they last treated against heartworm?*

Does your dog have any health problems?*

Vet name & number*

Has your dog been around children?*

If yes what is the youngest age?*

Describe what your dog is like around children.*

Describe what your dog is like with other dogs.*

Describe what your dog is like with cats.*

What is your dog like on a lead?*

What is your dog like off leash on either walks or in off leash exercise areas?*

What is your dog like during storms?*

Under what circumstances does your dog bark?*

How much obedience training does your dog have?*

Has the dog ever shown aggression towards other dogs?*

or Adults?*

or Children?*

Has your dog ever bitten another dog?*

or Adult?*

Or children?*

Do they dig?*

Do they jump, climb or dig under fences to escape?*

If yes, please explain*

Reason for giving up your dog*

Please write a description of your dog for the website*

Please attach Image of dog.

Max. file size: 16 MB.

I have answered the questions above truthfully and completely*