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 *
Spayed or Neutered? *
Is your dog potty trained? *
Why are you giving up your dog? Please be specific... *
Are you the legal owner of this dog? *
If not, please explain...
Is your dog good with cats? *
Has your dog been living with children? *
If yes, what ages?
Is your dog good with women? *
Is your dog good with men? *
How is your dog when he/she meets strangers? *
Is your dog good with other dogs? *
Where was your dog obtained? *
If rescue, which one?
If other, please explain...
How long have you had your dog? *
Does your dog have ANY health issues? *
If yes, please explain...Please also include current treatment. *
Has your dog been an... *
Your dog eats... *
Brand of Dog Food *
Quantity of food and how often? *
Is your dog crate trained? *
Where does your dog currently sleep? *
How much time does your dog spend alone during the day? *
Is your dog destructive when left in the house, alone? *
Where does your dog stay when you are not home? *
Does your dog have any separation anxiety? *
If "yes" or "sometimes", please elaborate and give details.
When left alone, does your dog... *
What games does your dog enjoying playing? *
Has your dog ever bitten or shown any aggressive tendencies: *
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: *
How does your dog react if you approach his toys, food, etc.: *
Has your dog had obedience training, even a basic class: *
How does your dog respond to commands: *
What is the best way to get your dog to listen/obey: *
Are you able to foster your dog until a new home can be found? *
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. *
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. *

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