Surrender Application February 9, 2021 by caroline Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone Number*Second Phone NumberEmail* How did you hear about us?*HiddenHIDDEN - email not text box How did you hear about us?* What is the dog's name, breed and age and how did you obtain him/her (friend, breeder, stray, etc.)?*How long have you had the dog?* Why are you giving up the dog?*Has the dog been spayed or neutered?* Yes No Unknown What is your veterinarian's name, city and phone number?*Has the dog received vaccinations? If yes, please give the date and type of last vaccines.*Does the dog have a microchip? If yes, please provide the brand and chip number.*What kind of food, how much and when do you feed the dog?*What kind of toys does the dog like to play with?*What kind of games do you play with the dog?*Has the dog been tied or chained?* All of the time Most of the time Some of the time Never Has the dog been in a fenced yard?* All of the time Most of the time Some of the time Never Has the dog been in a dog run?* All of the time Most of the time Some of the time Never Has the dog been outside free roaming? (not tied or contained by a fence)* All of the time Most of the time Some of the time Never Has the dog used a dog house?* All of the time Most of the time Some of the time Never Where has the dog lived?* In the house Outside Both Has the dog been confined in an indoor crate? If yes, for how long and how often?Has the dog been allowed on the furniture (couch, bed etc)?* Yes No Is the dog housebroken?* Yes No Has the dog ever marked in the house with urine?* Yes No Does the dog get along with other dogs in the household if any? If no, please describe the dog's behavior with other household dogs.*Does the dog get along with other dogs outside of any in the household? If no, please describe the dog's behavior with other dogs.*Does the dog get along with cats living in the household if any?* Yes No Don't know OR Not Applicable Does the dog get along with cats living outside of the household?* Yes No Don't know OR Not Applicable Does the dog get along with children in the household, if any? If no, please describe the dog's behavior in detail.*What aged children has the dog been around?*Has the dog had experience with any other types of animals? If yes, what kind and how does the dog get along with them?*Is the dog used to walking on a leash?* Yes No Has the dog received any obedience training? If yes, what methods of training have been used?*What commands does the dog respond to regularly?*What do you do if the dog misbehaves? Check all that apply.* Yell at the dog Spank or hit the dog Put the dog outside or in a separate area Ignore the dog Other (please explain below) HiddenWhat do you do if the dog misbehaves? Check all that apply. OLD RADIO set to INVISIBLE use CHECKBOX VERSION ABOVE Yell at the dog Spank or hit the dogs Put the dog outside or in a separate area Ignore the dog Other (please explain in the Additional Comments section below) Explain OTHER for "What do you do if the dog misbehaves?"*Does the dog have problems with any of the following. Check all that apply.* Chewing Digging Holes Barking Digging under fences Climbing or jumping over fences HiddenHIDDEN Does the dog have problems with any of the following. Check all that apply. Chewing Digging holes Barking Digging under fences Climbing or jumping over fences Has the dog ever bitten or scratched anyone? If yes, please explain.*Have you ever tried to take food, treats or valued toys from the dog? If yes, what was the dog's reaction.*Does the dog have any behavioral problems? If yes, please explain.*What parts of its body does the dog NOT like to have touched? What does the dog do to show you he/she doesn't like it?*What adjectives best describe the dog? Check all that apply.* Easy going Shy Aggressive Active Friendly Dominant Protective Hyperactive HiddenHIDDEN What adjectives best describe the dog? Check all that apply.* Easygoing Shy Aggressive Active Friendly Dominant Protective Hyperactive Please detail any additional information you can provide about the dog's personality or habits.*Additional Comments:PhoneThis field is for validation purposes and should be left unchanged.
