1. Welcome to Pit Bull Chat!

    We are a diverse group of Pit Bull enthusiasts devoted to the preservation of the American Pit Bull Terrier.

    Our educational and informational discussion forum about the American Pit Bull Terrier and all other bull breeds is a venue for members to discuss topics, share ideas and come together with the common goal to preserve and promote our canine breed of choice.

    Here you will find discussions on topics concerning health, training, events, rescue, breed specific legislation and history. We are the premier forum for America’s dog, The American Pit Bull Terrier.

    We welcome you and invite you to join our family.

    You are currently viewing our boards as a guest which gives you limited access to view most discussions and access our other features. By joining our free community, you will have access to post topics, communicate privately with other members (PM), respond to polls, upload content and access many other features. Registration is fast, simple and absolutely free so please, join our community today!

    If you have any problems with the registration process or your account login, please contact us.

    Dismiss Notice

Sample Owner Surrender form

Discussion in 'Rescue & Adoption' started by maryellen, Sep 13, 2007.

  1. maryellen

    maryellen Good Dog

    Owner Surrender Application

    Please complete this application in full. Incomplete applications will not be processed __________________________________ is under no obligation to accept any animal into its care.


    Current Owner Information:

    Name: ________________________________________________________________________
    Address: ______________________________________________________________________
    City: _____________________State: _____________________ Zip Code: _________________
    Phone Number: ______________ Alt. Phone: ___________ Will you accept a collect call? ____
    Best time to call? _________________ E-mail Address: ________________________________
    How did you hear about ___________________(Shelter / Rescue Name)
    ____________________________________________________________________________________________________________________________________________________________

    Identifying Information:
    Name: __________________________________ AKC Registration: _____________
    Name and contact information for the breeder: ________________________________
    _____________________________________________________________________________
    Date of Birth: ____________ Sex: ___________ Spayed/Neutered? ___________________
    Tail Docked? _____________ Tattooed / Microchipped? ____________________________

    Health Profile: (medical records must be provided before surrender)
    Veterinarian and contact information: _______________________________________________
    ______________________________________________________________________________
    Name of client your dog is listed under at vet: _________________________________________
    Is your dog currently vaccinated? __________Date of last veterinary appointment:____________
    Date of last heartworm test: ___________ Which brand of heart worm preventative is your dog currently taking? _____________________ Date of last dose: ____________________________
    Date of last Lyme Dz test: ______________ Is your dog vaccinated against Lyme Dz?_________
    List any major medical conditions or surgeries your dog has ever had: ______________________
    ______________________________________________________________________________
    Personality Profile: (please be as detailed as possible)
    Has your dog ever bitten, nipped, or snapped at a person? ________________________________
    Does your dog bark or growl aggressively at people or other animals? ______________________
    Is your dog shy or afraid of anything? _______________________________________________
    Describe your dogs temperament? __________________________________________________
    Has your dog lived with children? _______________ Ages? _____________________________
    Is your dog good with children? ____________________________________________________
    Has your dog lived with other animals? ______________ What kind? ______________________
    ______________________________________________________________________________
    Is your dog good with cats and small animals? ________________________________________
    is your dog good with other dogs? __________________________________________________
    Has your dog ever fought with another dog or animal? __________________________________
    Is your dog crate trained? ______________ Housebroken? _______________________________
    Where does your dog stay when left alone? ___________________________________________
    Does your dog have any destruction habits? ___________________________________________
    Does your dog like car rides? ______________________________________________________
    What are some activities your dog likes? _____________________________________________
    ______________________________________________________________________________
    What are some activities your dog dislikes? ___________________________________________
    ______________________________________________________________________________
    Has your dog had any formal training? _______________________________________________
    Has your dog ever been protection trained? ___________________________________________
    Can you disturb dog while eating? _______ Sleeping? ________Playing with toys? ___________ Does your dog guard any persons or objects? _________________________________________
    Describe your dogs activity level? Very High, High, Medium, Low, Very Low
    What brand of food and what quantity does your dog eat? _______________________________
    What type of home would you feel would best suit your dog? ____________________________
    ______________________________________________________________________________

    Character References: (please provide complete contract information for three different people who are personally familiar with your dogs character)
    Reference 1: ___________________________________________________________________
    Reference 2: ___________________________________________________________________
    Reference 3: ___________________________________________________________________
    Additional Comments?
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________
    ______________________________________________________________________________

    I certify that the information provided on this form is true and correct. I understand that providing this information, I am under no obligation to relinquish my dog to ________________________ nor is ______________________________ under any obligation to accept my dog.

    Signature of owner: _______________________________________ Date: _________________
    _________________
     

Share This Page