Peppertree Rescue - Surrender Application

		Peppertree Rescue

Adoption Clinics

Applications and Forms

Donations and Shopping

Lost Dog Resources

Neighbor's Corner

Owner Surrender

Pet Friendly Apartments

Trial Placement

Peppertree Store

Shirt

Next Adoption Clinic

Saturday, May 18, 2013
10:00 am - 1:30 pm
Latham Farms PetSmart, 601 Troy-Schenectady Road, Latham, NY 12110

Clinic Schedule

HELP NEEDED:

Our special dogs need your help and we do too!
Help Peppertree

Subscribe Now!

© Copyright 2006
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?

Security Image:

Security Image Text (above):

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 01:08:24 on 08/07/2009.