Peppertree Rescue
 
 
 
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Next Adoption Clinic
 

Saturday, August 2, 2014
10:00 am - 1:30 pm

Latham Petco, Fresh Market Commons, 664 New Loudon Road, Latham, NY 12110

Clinic Schedule
 
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Peppertree Rescue
All Rights Reserved
 

Surrender Application

Name of dog:
Breed:
Age:
Birthdate:
Sex:
Owner First Name:   Last Name:
Street Address:
City:    State:    Zip Code:   
Home Phone:    Work Phone:
Email Address:
Is this dog spayed/neutered?
Licensed?
Does it have its AKC papers?

How long have you owned this dog?
Where did you get this dog?
Dog's breeder (if known):
Does the breeder know that the dogs needs a new home?
Why are you giving up the dog?
Is this dog housebroken?
Has the dog ever been neglected or abused?
Is the dog friendly with:   Adults    Men    Women
Children    Strangers    Other Dogs    Cats
Children (give ages):
Does the dog alarm bark?
Do you consider the dog to be protective?
Has the dog ever bitten anyone or shown other signs of aggression?
 
Has the dog ever received obedience training?
Where was the dog primarily kept?
How often and what kind of exercise does the dog get:
What type and brand of food is the dog currently eating:
Any food it cannot eat:
Does the dog know the following commands:  
  • Sit   
  • Down   
  • Stay   
  • Heel   
  • Come
  • Other commands:
Is the dog currently under veterinary care?
When did the dog last receive the following:
  • Rabies (note if 1 or 3 year vaccination):
  • DHLPP (distemper/parvo):
  • Heartworm test (positive/negative):
  • Bordetella (kennel cough):
  • Lyme disease vaccination:
  • Worming:
Is the dog currently taking heartworm preventative?
Is anything being used for flea control?
Does the dog have any of the following:
  • Heart Problems
  • Respiratory Problems
  • Skin Problems
  • Digestive Problems
  • Eye Problems
  • Hip Problems
  • Allergies
  • Hepatitis
  • Diabetes
  • Muscular Disease
  • Dental Problems
  • Cancer
  • Other
Are you aware of any other medical or behavioral problems that would be important to someone interested in adopting this dog?
Are you willing to allow the dog to remain with you until an appropriate home is found?
 
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BY CLICKING SUBMIT, I ACKNOWLEDGE THAT ALL THE INFORMATION CONTAINED IN THIS FORM IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY MISREPRESENTATIONS OF FACT MAY RESULT IN THE REMOVAL OF THE ADOPTED DOG FROM MY HOME BY PEPPERTREE.
 
This page was last modified at 14:05:35 on 05/30/2014.