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Relinquishment Form
* Required fields
Name *
E-mail Address *
Address *
City *
Zip Code *
Home Phone Number *
Cell Phone Number *
Name of your dog *
Breed or Primary Breed Mix *
Aproximate age of dog *
Apriximate size of dog (in pounds) *
Sex of your dog *
Male
Female
Spayed or Neutered? *
Yes
No
Is your dog potty trained? *
Yes
No
Why are you giving up your dog? Please be specific... *
Are you the legal owner of this dog? *
Yes
No
If not, please explain...
Is your dog good with cats? *
Yes
No
Unknown
Has your dog been living with children? *
Yes
No
If yes, what ages?
Is your dog good with women? *
Yes
No
Is your dog good with men? *
Yes
No
Some
How is your dog when he/she meets strangers? *
Friendly
Timid/Shy
Aggressive
Obnoxious
Is your dog good with other dogs? *
Yes
No
Some
Where was your dog obtained? *
Rescue
Friend
Pet Shop
Pound/Shelter
Breeder
Gift
Other
If rescue, which one?
If other, please explain...
How long have you had your dog? *
Does your dog have ANY health issues? *
Yes
No
If yes, please explain...Please also include current treatment. *
Has your dog been an... *
Indoor Pet
Outdoor Pet
Indoor/Outdoor Pet
Your dog eats... *
Dry Food Only
Wet Food Only
Dry/Wet Both
Brand of Dog Food *
Quantity of food and how often? *
Is your dog crate trained? *
Yes
No
Where does your dog currently sleep? *
Bed with you
Outside
In garage
Where he/she wants in the house
Crate
How much time does your dog spend alone during the day? *
Is your dog destructive when left in the house, alone? *
Yes
No
Sometimes
Where does your dog stay when you are not home? *
Inside
Outside
Indoors/Outdoors (Doggie Door)
Does your dog have any separation anxiety? *
Yes
No
Sometimes
If "yes" or "sometimes", please elaborate and give details.
When left alone, does your dog... *
Doesn't care
Whines/Cries
Barks/Howls
Destructive
What games does your dog enjoying playing? *
Frisbee
Fetch
Tag
Tug-o-War
Ball
None: Couch Potato
Has your dog ever bitten or shown any aggressive tendencies: *
Yes
No
If yes, to whom, and under what circumstances (please be honest, you will be liable if this dog is placed and bites someone and you were aware that the dog had a history of biting)
Is your dog possessive of toys, food, or his/her people: *
Yes
No
How does your dog react if you approach his toys, food, etc.: *
Has your dog had obedience training, even a basic class: *
Yes
No
How does your dog respond to commands: *
Excellent
Good
Fair
Poor
When HE/SHE wants to...
What is the best way to get your dog to listen/obey: *
Praise
Treat
Correction
Firm Voice
Are you able to foster your dog until a new home can be found? *
Yes
No
Possibly, depends on time frame.
If "yes" or "possibly", please give us the latest date you can keep the dog...
All statements made above are truthful to the best of my knowledge. I understand that I may retain liability if I have knowingly misstated the truth about my dog and he causes injury to humans, other animals, or property. I also understand that I am not entitled to any form of compensation for this dog. *
Accept
Do not accept
I understand that Love 4 Canines will need the following upon transfer of dog:A copy of dog's medical records, including spay/neuter certificate, rabies certificate, and proof of current DHLPP shot. *
Yes
No
I have read and agree to the
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