Dog Surrender Form

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Dog Surrender Form

Please Fill out this form completely. This information will allow us to find the right new foster or Furever home for him and or her. Please be honest and accurate. You will hold your dog until an appropriate foster or furever home is found. Please email pictures directly to us at www.affrescue.com questions email Affrescue@aol.com. We look forward to helping your dog find his or her new home.

Owners Information - Name

Todays Date

YYYY

Home Number

Cell Number

Work Number

Full Address

Email Address

Dogs Information - Name
*

Breed or Breeds of your dog?

Is your dog a Male or Female?

Female

Male

Clear selection

What is your dog's Age?

what is your dog's Weight?

Is your dog Spayed or neutered?

Spayed

Neutered

Do not know

Is your dog Current on Shots? Date of last Shots?
*

Name and number of vets who cares for your dog?

How long have you owned your dog?

Is your dog housetrained?

Is your dog Crate trained or have run of the house when home alone?

If the Dog has (run of the house) How long can he or she be alone before becoming destructive?

Is your dog an excessive barker? (If yes please explain)

Is your dog on heart worm medicine? Date of last dose?

Is your dog on flea and tick medicine? Date of last dose?

Is your dog Microchipped? (Please provide microchip number and company.)

Is your dog Good with Other dogs?

Is your dog Good with cats?

Is your dog Good with kids? What age kids?

Is your dog accustomed to a fenced-in-yard? What height and type fence?

Is your dog basically an indoor pet? (Please explain.)

Does your dog Walk well on a leash?

Is your dog an escape artist? (If yes please Explain.)

Is your dog good with company and strangers?

Has your dog shown any kind of aggression? (If yes please explain the circumstances fully.)

To your knowledge has your dog Ever BIT a person or another animal? (If yes please explain the circumstances Fully)

Is your dog Food Aggressive? (If yes please explain the circumstances.)

Is your dog Still mouthing? (Puppies)

Personality and temperament of your dog?

What is the reason for giving up your dog?

Profile for your dog? (This is what people will read when viewing the dog on our site.)

Any bad habits? (Please explain)

Any health problems? Please explain)

Name and Number of vet who cared for your dog?

Are there Any other significant facts we should know about your dog?

I do attest that the dog has never been aggressive to people or another animal (If dog has been aggressive, I have written it in the above field and have been honest in my description of the dog(s) behavior). By signing below, I attest that all information given to AFF on this form is true. I understand and agree to follow AFF's terms and conditions in helping me place my dog in a new home. NOTE: Typing your name is accepted as your Owners signature.

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