Dog Owner Surrender Form – Voorhees Animal Orphanage

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Dog Owner Surrender Form

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Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Occupation *

Dog's Name *

Dog's Age *

Dog's Gender *

Male
Female

Dog's Breed *

Spayed/Neutered? *

Yes
No

Reason for surrender *

Where did you get the dog from? *

How long have you owned the dog?

Is your dog house trained? *

Yes
No

Is your dog crate trained? *

Yes
No

Does your dog have any medical conditions? *

Yes
No

Please explain your dog's medical conditions:

Veterinarian Name *

Veterinarian Phone Number *

Is your dog up to date on vaccines and heartworm test/treatment? *

Yes
No

Has your dog ever bitten anyone? *

Yes
No

Please explain the dog bite incident(s):

What commands does your dog know? *

What is your dog’s energy level? *

Does your dog like children? *

Yes
No

What ages is your dog comfortable with?

0-2
3-5
6-9
10-12
13-17

Please choose all that apply.

Is your dog destructive to furniture or belongings? *

Yes
No

When does the destruction occur?

Which best describes your dog? *

Submissive
Dominant

Does your dog get along with other dogs? *

Yes
No

Does your dog get along with cats? *

Yes
No

Does your dog have food aggression? *

Yes
No

Does your dog have fear aggression? *

Yes
No

List of genders and ages of people living with the dog now: *

Please describe how the dog reacts to the people it lives with: *

Please describe how the dog reacts to visitors: *

Is this your first dog? *

Yes
No

Please describe the ideal home for your dog: *

Please upload a photo of your dog:

Click or drag a file to this area to upload.

Additional Comments

Name

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