Small K-9 School & Rescue Dog Surrender Form
DOG’s Name:______
Basic Information
Gender: ______Spayed/ Neutered: ______Age:______
Type: ______Breed: ______Colour:______
Current owner’s name______
Address______
Tel:______Cell______
Email______
History
Why are you surrendering your DOG to Small K-9 School? ______
How long how you owned the DOG? ______
Where did you get thisDOG? ______
Has your DOG ever bitten anyone before? ______
If yes, under what circumstances and when? ______
______
Medical History
Name of veterinarian and veterinary clinic: ______
Has this DOG seen a veterinarian at least once per year? ______
Has this DOG ever required medical surgery and why?______
______
Has this DOG ever been diagnosed with a medical concern? ______
Is this DOG on any medication at this time? ______
Personality
Does your DOG like to be patted? ______
Doses your DOG like to be picked up? ______
Is your DOG housed indoors or outdoors? ______
What are your DOG’s favorite toys/games? ______
Does your DOG show any aggression towards any animals?______
What does it do?______
Has this DOG lived with another animal? _____
What kind, how did they interact?______
Has this Dog lived with cats, how did they interact?______
______
Has this DOG has lived with dogs, how did they interact?______
______
______
Has the DOG lived with children? ______
If yes, what ages: ______
How would you describe your DOG’s personality most of the time?______
______
What are some not desirable behavoiours that you dog possess? (This question needs to be answered honestly!!!This helps providesme with valuable information into your pet and can help me ensure your pet has a successful adoption. Many behaviour issues dogs have are normal and common behaviours and maybe to a particular breed of dogs. They also usually have simple solutions to resolve.______
______
______
Is there any else that you would like me to know about your dog? ______
______What would the dog come with?______
______
Signature of the surrendering owner:______
I am a small rescue and rely on donations to exist.
I ask for a surrender donation of minimum of $50 or ______(how much you can donate) and a FULL bag of current food.
Your surrender Donation goes towards:
Providing food
Veterinary care, Vaccinations, De-worming treatment
IF YOUR DOG IS NOT FIXED YOU NEED TO GET IT FIXED BEFORE IT IS ADOPTED OR YOU NEED TO DONATE $100 AND I WILL DO THAT!!!
RELEASE AND SURRENDER
I, ______, being the owner of ______(dog’s name), hereby relinquish any and all claims and ownership of said animal to the organization known as Small K-9 School, Kids Helping K-9s Club Rescue and its volunteers. By executing this document I acknowledge that I will not be able to reclaim this animal once it is in the possession of Small K-9 School. I also give Small K-9 School my authorization to get any, and all available medical records from______veterinary clinic.
Sign______
Phone: (______)______
Date______
Witnessed: ______
Phone: (______)______
Date______