Surrender a Dog

Please note, this form is designed to help you provide as much information to us about your dog as possible. At the point of hand over, you will be expected to sign a printed version of this form.

Todays date

Dogs Name

Age (years and months if possible)

Breed

Sex
malefemale

Spayed/Neutered
yesno

Microchipped?
yesno

Chip number

Why are you surrendering this dog? Please give as much information as you can.

How log have you owned the dog?

How many homes has the dog had including the breeder?

Where did you get the dog?

Has the dog bitten a person in the last 10 (ten) days?
noyes

If yes, please give the date, place (city) and name of the person bitten

Has the dog ever:-
BittenScratchedLunged or attackedNone of these

If yes, did a bite break the skin?
noyes

Were the police involved?
noyes

Please explain the circumstances

Please give the name, address and phone number for the dog's veterinarian

Is the dog current on vaccinations?
noyes

Please list any past or present injuries, treatment or other medical history

Please check all of the following that describes the dog
very activecouch potatobarks a lothowlsquietplayfulfriendlyshylikes to be touchedaffectionatefearfulindependentprotectivealways at your sideindoor dogoutdoor dognervoushouse trainedcrate trainedlikes menlikes womenworked livestockused for huntingseparation anxietydiggerjumps fences

How high could your dog jump a fence?

Has the dog lived with children?
yesno

If so, what ages?

Would you recommend the dog live with children in the future?
yesno

Has the dog lived with cats?
yesno

Would you recommend the dog live with cats in the future?
yesno

Has the dog lived with other dogs?
yesno

If yes, please describe the other dogs

Would you recommend the dog live with other dogs in the future?
yesno

What are the dogs favourite activities or objects?

What does the dog dislike or fear?

Where is the dog kept during the day?

Where does the dog sleep at night?

Does your dog travel well in the car?

What type of food do you feed your dog?

Is there anything else a future owner should know about this dog?

my signature below certifies that I am the owner of, or have the authority to surrender to Cupcakes Rescue, the animal described above. I hereby relinquish all rights of ownership and any right to information on the disposition of said animal. I also authorise the release of any veterinary records regarding the animal. I certify that to the best of my knowledge, I have disclosed all information about the animal concerning health, behaviour, history and anything else that may affect the safe placement of the animal in a new home and that all statements made above are true and correct.
Signature Date

Please print full name

Please provide the best phone number to contact you on

First line of your Address

Postal Town

County

Postcode

Your Email (required)

I hereby acknowledge that I have been notified of and fully understand the following conditions of my relinquishment of this animal:-

Pupcakes Rescue shall have sole and exclusive legal right to make all outcome decisions and take all actions deemed appropriate

Pupcakes Rescue are under no obligation to communicate the outcome of the animal to you or any other party, however you may see updates of the dog on our Facebook page or website

Pupcakes Rescue spends an average of £450 on food, shelter, medical and other care for each animal we receive. If you are able, please consider making a donation to help us care for your dog. Thank you!