Surrender Form Surrender Form Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone Number*Second Phone NumberEmail* 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?*YesNoUnknownWhat 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 timeMost of the timeSome of the timeNeverHas the dog been in a fenced yard?*All of the timeMost of the timeSome of the timeNeverHas the dog been in a dog run?*All of the timeMost of the timeSome of the timeNeverHas the dog been outside free roaming? (not tied or contained by a fence)*All of the timeMost of the timeSome of the timeNeverHas the dog used a dog house?*All of the timeMost of the timeSome of the timeNeverWhere has the dog lived?*In the houseOutsideBothHas 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)?*YesNoIs the dog housebroken?*YesNoHas the dog ever marked in the house with urine?*YesNoDoes 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?*YesNoDon't know OR Not ApplicableDoes the dog get along with cats living outside of the household?*YesNoDon't know OR Not ApplicableDoes 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?*YesNoHas 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 dogSpank or hit the dogsPut the dog outside or in a separate areaIgnore the dogOther (please explain in the Additional Comments section below)Does the dog have problems with any of the following. Check all that apply.ChewingDigging holesBarkingDigging under fencesClimbing or jumping over fencesHas 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.*EasygoingShyAggressiveActiveFriendlyDominantProtectiveHyperactivePlease detail any additional information you can provide about the dog's personality or habits.*Additional Comments:EmailThis field is for validation purposes and should be left unchanged.