Name
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First Name
Last Name
Email Address
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Phone
(###)
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Address
City, State, Zip
Dog's Name
Dog's Age
Dog's Breed - If mixed breed, best guess
If you completed a DNA test, what were the results?
Gender
Is the dog Spayed or Neutered?
Is the dog microchipped?
If yes, where is the chip registered?
Do you agree to transfer registration to the rescue?
Please let us know why you are surrendering this dog
Does the dog have a history of aggression?
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Does the dog get along with...
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Please check all that apply.
Does the dog show any signs of possession with food or toys?
Yes
No
If yes, please describe
Has the dog ever lunged, growled or bitten someone?
If yes, please describe what happened
Is the dog house trained?
Is the dog crate trained?
Where does the dog usually sleep at night?
Do you agree to provide current medical records from your veterinarian? Your vet can fax them to 802-482-2712 or email to 802dogrescue@gmail.com.
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When was he last given heartworm preventative? What brand was it?
When was he last given flea/tick preventative? What brand was it?
Does your dog have any medical conditions that require treatment?
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If yes, please describe.
What brand of food is he eating?
When does he normally eat?
How much food is he given per meal?
Has your dog participated in any group or private training classes?
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List any commands or words your dog has learned.
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Please share anything else about this dog that will help us find the perfect new home
Do you agree to relinquish all rights to this dog?
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By submitting this form, I certify that information contained within is true and complete. I authorize VT Dog Rescue to advertise this dog for adoption and to try to place the dog in a suitable home.
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Please enter your name & date here to certify & accept terms.
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