Sophie’s Circle Dog Rescue

Owner Surrender Form

Please fill out this form to the best of your ability. Your answers will help us to get to know the animal and give us some background inforamtion. This will ensure we are able to place in a new home that is best matched with his/her personality and needs.

Owner’s inforamtion

Name:
Street Address: / City: / State:
Zip Code: / Phone:

Dog’s Information – General

Name: / Breed: / Gender / Male or Female
Age: / Microchipped? / Is your dog: / Spayed Neutered Not Altered
Why are you surrendering this dog?
How long have you had this dog?
Where did you get this dog?

Dog’s information – Medical

Has this dog bitten in the last ten day? If yes, explain
Does this dog have/had any known medical issues?
What vet clinic do you use? Phone Number?
What type of food do you feed this dog?
Is there any type of food/treat this dog particualry like?

Dog’s information – Behavior

Does this dog have any of the following behavioral issues? Please explain each issue. (Please be honest, it will let us know what things we should work on with the dog)

Issue Explain

Separation or other anxiety
Chewing
Excessive Barking
Digging
Inappropriate Urinating
Begging
Chasing (cars, animals, people etc)
Protective of house, family etc.
Jumping Up
Biting
Aggression
Fear of loud noises/objects

How does this dog respond to:

Cats
Other Dogs
Strangers
Children
Has this dog ever killed or injured another animal?
If yes explain:

Dog’s information – Training

Is this dog housebroken?
Has this dog had formal obedience training?
Does this dog know any commands? If yes explain:
Has this dog been crate trained?
Can this dog be trusted to be home alone for extended periods?

Please take some time to tell us anything else about this dog that you think we should know or that you would like us to know:

We would greatly appreciate it if you can make a donation to Sophie’s Circle toward the vet care of your dog. We run our rescue solely on donations. Any amount would be greatly appreciated. An average dog without ANY health issues, costs us at least $150.

I would like to make a donation: YES or NO

Amount: ______

Type of payment? Paypal () Check mailed to 1228 Wayne Ave NSB 32168, or credit card (386)690-6771

Please understand that you completely give up the ownership and all right to this animal when you surrender it to Sophie’s Circle Dog Rescue.

Signature: / Date: