Pet Personality Profile

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Stafford Animal Shelter - Surrender Form

Email *

Date\

YYYY

Pet's Name

Pet's Age

Species

Dog

Cat

Other:

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Breed

Sex

Male

Female

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Is your pet spayed / neutered?

Yes

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Is your pet microchipped?

Yes

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If yes, provide microchip number please.

How long have you cared for this pet?

How many homes has this pet had?

Where did you get this pet?

For what reason are you surrendering this pet?

Has this pet ever bitten a human? If yes, please explain in box below.

Yes

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Had this pet ever bitten another animal? If yes, please explain in box below.

Yes

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Aggression & Predation Response: Please list and describe, in detail, all incidents in which this pet has bitten a human or other animal. Include the age, gender, and species of the bite victim, the environment in which the bite occurred (home, pet park, sidewalk, etc.), the pet’s energy when the bite occurred, and the amount of physical damage that the victim sustained.

Who is your pet's veterinarian?

Is your pet current on vaccinations?

Yes

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Please list any past or present injuries, treatments or medical history:

Please check all that describe this pet:

Escape Artist

Needy / Always with you

Hunter / Explorer

Vocal

Confident

Bashful

Food Motivated

Toy Motivated

Nervous

Aloof

Gentle

House Trained

Litter Box Trained

Forceful

Digger

Playful

Crate Trained

Anxious

High Energy

Independent

Separation Anxiety

Likes Men

Likes Woman

Like Children

Has this pet lived with children?

Yes

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If yes, what ages?

Would you recommend it lives with children in the future?

Has this pet lived with cats?

Yes

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Would you recommend it lives with cats in the future?

Has this pet lived with dogs?

Yes

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Would you recommend it lives with dogs in the future?

Has this pet lived with small animals or livestock?

Yes

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Would you recommend it lives with them in the future?

Does this pet travel well in a car?

Yes

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What are the pet's favorite objects / activities?

What does this pet dislike / fear?

Is there anything a future adopter should know?

By initialing below, I certify that all the information I have provided herein is true and correct to the best of my knowledge:

Person's Name:

Person's Phone

Person's Address

A copy of your responses will be emailed to the address you provided.

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