Surrendering Form

 

Please fill out the following form below. *Note: You will need to email pictures to dron95@yahoo.com when complete.

If you’d like to print out the form and mail it to DRON please click here for a printable version.

BASIC INFORMATION

Your Name: (* = required)

Address: (* = required)

City: (* = required)

State: (* = required)

Zip Code: (* = required)

Your Email: (* = required)

Home Phone: (* = required)

Cell Phone:

Work Phone:

What is the best time to contact you:

DOG'S INFORMATION

Dog's Name: (* = required)

Dog's microchip # and company info:

Color of Dog:

Sex:

Spayed/Neutered:

Tail Docked:

Ears Cropped:

Date of Birth/Age:

How Long Owned:

Current Veterinarian name and phone number:

Is the dog current on the following?
(please email dron95@yahoo.com as backup)

Rabies (date of last shot and certificate number)

DHLPP:

Bordatella:

Date of last heartworm test:

Date of last heartworm preventative given:

Why is the dog being given up?

Where did you get the dog? (if from a breeder, shelter or rescue please provide that information)

Where was the dog allowed to be when you where home:

Where was the dog allowed to be when you where NOT home:

How long was the dog left alone each day?

Where did the dog sleep?

Who lived with the dog? (specify ages of all people)

How did the dog behave towards others living in the home? Were there any issues?

How did the dog behave around children?

Would you recommend this dog be placed in a home with children? What ages?

Does your dog know the following

How to: Sit

How to: Come

How to: Lie Down

How to: Heel

Other?

Additional Information

Walk nicely on a leash:

Ride nicely in a vehicle:

Was the dog taken to obedience class or did you use a private trainer?
(Please provide info on where you went or who you consulted)

How does the dog do for having toenails trimmed:

Does the dog have any bad habits in the house if unsupervised:

If answered "other" please explain

Please describe any fears the dog many have of people or things in detail:

Is the dog housebroken:

Crate Trained:

Does it have accidents in the house:

If so: How often?

What has been done to help this?

When outside the dog is:

If answered "other" please explain:

Does the dog have any outside habits we should be aware of (i.e. jumping fence, digging)?

Are there any animals the dog does not get along with?

Has the dog ever killed another animal that is smaller like a cat?

Does the dog get along with other dogs:

Please explain any issues with other dogs in this area:

Does the dog have any injuries or health issues? Please explain in detail including any medications it must take:

How often do you feed the dog and how much?

What brand of food are you using?

Please list any vitamins or supplements you use for the dog:

What toys does the dog like?

Has the dog ever bitten, snapped or growled at anyone? Explain situation and results:

Is there anything the dog will chase:

If answered Other for above question please explain:

Do you allow the dog on the furniture?

Do you allow the dog on your bed?

Please give us your best description of your dog's personality:

Please list an additional information you'd like to share about your dog here:

To my knowledge, no one has been bitten or scratched by this animal in the past fourteen (14) days. To my knowledge, the above answers are true and correct. I understand a give-up fee may be required. None of the answers to the above questions will necessarily exclude any dog from being taken into our program. All of the members of our organization are volunteers and all of our dogs are “fostered” in private homes, which often include other dogs, both big and small, cats, other pets, children, etc. Being as truthful as possible enables us to place the dog in an appropriate foster home without endangering our volunteers.

Name (* = required): (your name entered here will be considered your signature)

Date (* = required):

Please Note: *Our intake team will review the form and contact you. If the dog is accepted into the program we will have a separate form for you to sign to relinquish ownership.