Surrender Form

Breed: Please Select Pug Pug Mix French Bulldog French Bulldog Mix English Bulldog English Bulldog Mix Other Gender: Male Female   Spayed / Neutered: Yes No   Dog's Name:   Color:   Tatoo / Microchip: Tatoo Number Microchip Number Rabies Tag: Yes Number No   Date of Birth Age: Years Months Registered: Yes No   Housetrained: Yes No   Crate Trained: Yes No   Leash Trained: Yes No   Other Training: Please explain Dog Friendly: Yes No     Cat Friendly: Yes No     Child Friendly: Yes       Acquired Where? Please Select Rescue Pet Store Breeder Other Name of facility: Acquired When? DHLP_P: Yes No Last received: Rabies: Yes No Last received: Heartworm Test: Date of last test: Result: Positive Negative If positive, was heartworm treatment given? Yes No     Heartworm Prevention Yes No Brand: Heartworm Prevention Last Given:   Health Problems: Please be honest when telling us about any health problems. We do not turn away rescues with health issues, but it makes us better prepared when screening for foster homes. Surrendering Agency (if applicable): Contact Name: Contact Address: Phone: Home:     Business:     Cell:     Email Address: Second email: Training Problems: Temperament (please explain): Please explain the overall temperament of this dog. Include any issues with other dogs, cats, children, etc. For the safety of this animal, as well as members of the foster family, please be as specific as possible. Reason for surrender: Date:   << Go Back To PLR