Surrendering your Dog Surrendering your Dog Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Dog's name*Sex*MaleFemaleAltered*YesNoBreed(s)*Age/ Date of Birth*Approximate Weight*Microchipped*YesNoIf yes, name of company/chip #Where did you get this dog?*How long have you had this dog?*How many homes has this dog (including yours)?*Why do you need to rehome this dog?*How have you attempted to resolve behavioral issues (if applicable) prior to deciding to rehome?*What does your dog eat? (Brand and variety)*Free-feed?*YesNoIf No, how many cups per feeding and how many times a day?Any special diet requirements or allergies?*Favorite treat(s)?*Name of Veterinarian/Clinic:*Veterinarian/Clinic phone number?Date of last Vet visit and reason?*Date of DA2PP vaccine?*Date of Bordetella vaccine?*Date of Rabies vaccine?*Has your dog been tested for Heartworm in the past year?*YesNoIf Yes, date of test?Is your dog currently on a heartworm preventative?*YesNoIf Yes, brand and when was last does given?Please list/describe any current medical concerns*Please list/describe any significant medical history, including approximate dates*Please list any current medications or supplements your dog is takingHas this dog ever bit or nipped a person?*YesNoIf Yes, explain the situation, when it occurred and if it was an adult or a childHas this dog ever bit or nipped another animal?*YesNoIf Yes, explain the situation, when it occurred and the other animal involvedIs there anywhere your dog does not like to be touched? How does the dog react to that touch?*How does your dog react if you take away its food, treat/rawhide, or toy?*How is your dog around other dogs? Specifically bigger dogs, smaller dogs or dogs of the opposite sex?*How is your dog around people? Specifically kids (include ages), men, women and strangers?*How is your dog around cats and other small animals? Please be specific*How does your dog behave on a leash?*How does your dog behave on a leash around other dogs?*How does your dog behave in the car?*How does your dog behave in a crate?*What are your dog’s favorite toy(s) and/or games?*What makes your dog nervous/anxious/fearful?Is your dog*House trainedLeash TrainedCrate TrainedMy dog knows*SitDownStayComeDrop itAdditional skills?Has your dog attended any training classes or worked with a professional trainer? Please describe and provide the name of the trainer.*How do you discipline your dog, when necessary?*What training does your dog need to work on?*List all people and animals this dog currently lives with (including ages):*What kind of exercise does your dog get? How often?This dog spends time:*Mostly indoorsMostly outdoorsIndoors and outdoorsHow many hours per day is your dog left alone at a time?*Where do they stay when left alone?*How does your dog behave when left alone?*Describe your fence/yard setup:*Does your dog have a history of escaping? Please explain.*Describe the ideal home for this dog.*Is there anything else that might assist us in meeting the needs of this dog at the shelter and/or safely and successfully placing this dog in a new home? This iframe contains the logic required to handle Ajax powered Gravity Forms.