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.

Surrender Form

Owner’s Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dog’s Information – General

Name(Required)

Breed(Required)

Age(Required)

Gender(Required)

Male

Female

Microchipped?(Required)

Yes

Is your dog(Required)

Spayed

Neutered

Not Altered

Why are you surrendering this dog?(Required)

How long have you had this dog?(Required)

Where did you get this dog?(Required)

Dog’s information – Medical

Has this dog bitten in the last ten day? If yes, explain(Required)

Does this dog have/had any known medical issues?(Required)

What vet clinic do you use? Phone Number?(Required)

What type of food do you feed this dog?(Required)

Is there any type of food/treat this dog particualry like?(Required)

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)

Separation or other anxiety(Required)

Chewing(Required)

Excessive Barking(Required)

Digging(Required)

Inappropriate Urinating(Required)

Begging(Required)

Chasing (cars, animals, people etc)(Required)

Protective of house, family etc.(Required)

Jumping up(Required)

Biting(Required)

Aggression(Required)

Fear of loud noises/objects(Required)

How does this dog respond to:

Cats(Required)

Other Dogs(Required)

Strangers(Required)

Children(Required)

Has this dog ever killed or injured another animal? If yes explain:(Required)

Dog’s information – Training

Is this dog housebroken?(Required)

Has this dog had formal obedience training?(Required)

Does this dog know any commands? If yes explain:(Required)

Has this dog been crate trained?(Required)

Can this dog be trusted to be home alone for extended periods?(Required)

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:(Required)

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(Required)

Date(Required)

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.

Donation