Surrender Form

Complete the Form Below

Contact Us

First Name

Last Name

Phone

Address line 1

Address line 2

City

Province

Postal Code

Are you the legal owner of the dog?

If no, please explain

Dog's name

Dog's sex

Dog's breed, best guess if unsure

Dog's approximate weight, best estimate if unsure

Dog's colouring: describe colours and patterns on coat

Why did the previous owners give up this dog, to the best of your knowledge, if applicable

Please let us know the reason you can no longer keep your dog, in as much detail as possible

How did you obtain this dog?

How many previous owners has this dog had, to the best of your knowledge

To the best of your knowledge, has this dog ever been physically abused or mistreated? Please explain

Has the dog seen a vet before? Which clinic if known

Is the dog spayed or neutered?

Has the dog had any other surgeries? If yes, explain

Does the dog have any known allergies, skin, or ear problems? If yes, explain

Has the dog had all of its vaccinations?

What and when were the dog's last vaccinations? Include brand and protein type if applicable

Does the dog have any scars or deformities?

Does the dog have any other known health problems?

Does the dog eat table scraps?

Does the dog mind being handled?

Does the dog mind having its nails clipped?

Has the dog ever seen a groomer?

Is the dog housetrained?

If not entirely housetrained, describe frequency of accidents

Does the dog signal when it needs to go out to potty?

Where does the dog sleep (crate, dog bed, human bed, combination, or other)

Does the dog chew things it isn't supposed to?

Is the dog used to being left alone? If yes, how long

Has the dog been kept outside unsupervised for extended hours?

Has the dog been kept on a chain outside unsupervised for extended hours?

Does the dog chase anything? (cars, bikes, people, cats, dogs, deer, livestock)

Does the dog bark at anything when on leash? (cars, bikes, people, cats, dogs, deer, livestock)

Does the dog jump fences?

Does the dog bark excessively indoors?

Does the dog run away if off leash?

Does the dog walk well on a leash? If no, elaborate

Is the dog used to riding in the car?

Has the dog been to obedience training?

Has the dog been exposed to any training tools? (E-fence, shock collar, other )

Does the dog know any commands? (sit, lie down, stay, come, leave it, fetch, shake a paw, other)

What are the personality traits that apply? (shy, outgoing, playful, active, obedient, quiet, submissive, easy going, aggressive, biter, one person dog, temperamental, protective, possessive)

This dog is friendly with: men, women, children, cats, other dogs, all of the above, none of the above

Has the dog ever met other dogs? If yes, how did they react?

Has the dog ever met cats? If yes, how did they react?

Has the dog ever met children? If yes, how did they react, how old were the children?

Please list anything this dog is afraid of

Has the dog ever growled over: people, kids, toys, food, crate, dogs, other

Does the dog have a bite history with any of the following: kids, adults, dogs, cats, other. If other, please explain

Does your dog have any cute mannerisms or habits that would be interesting to new owners?

Please share any other comments you feel are important

Are you willing to contribute a surrender donation of $50 to the rescue? This helps offset the financial burden the rescue incurs while your dog is in our care

Signature

Date

Opt-In

I certify to the best of my knowledge, the information provided in this form is true as of the date of this form. I agree that submission of this form will constitute a legally signed document.

Adopt a dog today!

Surrender Form

Complete the Form Below

Contact Us

Opening hours

Where to find us

1934 Caledonia Marydale Rd, Saint Andrews, Nova Scotia, CA

902 318 8985