ABC (A Better Choice) Dog Rescue - Surrender Application

Surrender Application

Personal Information

Name: *

Address: *

City, Province, Postal Code: *

Phone Number: *

Best time to reach you: *

Email Address: *

Dog's Information

Dog's Name: *

Breed: *

Sex: * Male Female

Age / Date of Birth: *

Spayed or Neutered: * Spayed Neutered

Colour: *

Weight: *

Microchip Info: *

Surrender Information

Where did you get the dog? *

How long have you had this dog? *

Why are you surrendering this dog? *

Health Information

When was the dog last vaccinated: *

Date of rabies vaccination: *

Is the dog on any medication? * No Yes

If yes, what kind and what for:

Name and address of veterinarian: *

Does the dog have any health problems such as ear infections, eye problems, luxating patellas (knees), renal problems, skin problems, other: *

Has the dog ever had surgery? If yes, please explain. *

Behavioural Information

How does the dog walk on leash? *

Is the dog housebroken/paper trained? * Yes No

Is the dog crate trained? * Yes No

Has the dog ever bitten you, another person, a child, or other animal? (Answering yes to this question will not automatically mean that your dog will not be accepted. ABC Dog Rescue needs to know all pertinent information so that the dog can be re-homed in a proper environment. Failure to disclose your dog's history of aggression could make you liable if someone is injured.) If yes, please explain. *

Has this dog ever been abused? If yes, please explain. *

Has the dog ever had any formal training? If yes, please give details. *

Does the dog know any commands or tricks? If yes, please describe. *

How does the dog react to the following

Children: *

Strangers: *

Men/Women: *

Dogs: *

Cats: *

Being left alone: *

Crate confinement: *

Grooming: *

Veterinarian: *

Traveling in the car: *

General Information

Where does the dog stay when you are not at home? *

Where does the dog sleep? *

What do you feed the dog? *

When does the dog eat? *

When does your dog go out? *

Is there anything special that your dog likes? *

Is there anything that your dog dislikes? *

What does your dog fear? *

Does your dog have any bad habits? *

Does your dog have a favourite toy? *

I certify that the above information is true and accurate to the best of my knowledge, and that I have not wilfully concealed information about this dog. I certify that I am the legal owner of this dog and I hereby apply to surrender this dog to ABC Dog Rescue for placement in a suitable home. I understand that if ABC Dog Rescue accepts my dog I will relinquish all ownership rights and I will not be provided with personal information about the new owner, and that the new owner will not be provided with my personal information. If my dog is accepted by ABC Dog Rescue I consent to pay a surrender fee to ABC Dog Rescue. I understand that this fee is used to cover any expenses incurred by ABC Dog Rescue in caring for my dog and preparing him/her for adoption. I understand that submission of this application is not a guarantee of acceptance.

Name:
Date:

Phone:	780-857-2817
Email:	abcdogrescue@hotmail.com

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