Owner Surrender Form

Owner's Information








Dog Information-General




 Male Female




 Yes No


 No Yes (Enter number if known)

Dog-Information Behavioral


 Yes No




 Yes No


 No Yes, please explain


 No Yes, please explain


 No Yes, please explain


 No Yes, please explain


 No Yes, in what situations


 No Yes, please explain


 Yes No


 Cats Other Dogs Strangers Children Other


 No Yes, please explain

Dog Information Medical



 Yes No



 No Yes, please explain


 No Yes, please list

Dog Information - Training


 Yes No


 Yes No


 Yes No


 Yes No


 No Yes, please list

Other Information




 Shelter Family/Friends Breeder Other