SaveADogRelinquishmentinformationform.docVIP

Save A Dog Relinquishment information form Your Name: ______________________________________ Organization Name: _______________________________________ Address: _____________________________________ Phone: _______________________________________ Dog’s Name: Breed: Sex: Age: Coloring: Spayed/Neutered? Have Certificate? Feeding Schedule: BRAND of Food: Known Allergies or medical conditions (please describe): Why are you giving the dog up? Can the dog stay with you while we find it a new home? If not, what is your deadline for relinquishing? Name/Phone of Previous Vet: Is this dog currently on any medications? If yes, please list with dosages. Vaccinations (Please FAX your dog’s medical and vaccination history to us at 877-349-9254): Date of Last Distemper: Date of Last Rabies: Have Certificate/Tag? Date Of Last Bordetella: Date of Last Heartworm Test: Results: Is this dog currently on HW preventative? Brand: Last Date Given: Is this dog currently on Flea/Tick preventative? Brand: Last Date Given: Is this dog paper trained/crate trained/other. Has dog ever been in a crate at all? (please describe): Is This Dog leash trained? Does this dog have any obedience training / know any commands (please describe). Where did you get the dog? Is this dog good with other dogs? Is this dog good with cats? Is this dog good with children? Is this dog overweight? _____________If so, why?_______________ Does this dog have any temperament issues that we should be aware of? Has the dog ever bitten anyone? What were the circumstances? Does this dog Jump Fences? Dig Under Fences? Trained on invisible Fence? Please explain. Describe any recent vet visits (especially if this is a dog being returned to Save A Dog who was recently adopted. What was the nature of the visit? Did s/he receive any vaccines? Is there anything else that we should know? Are you able to pay the intake fee? We require a minimum $150-250 donation if you are returning a dog you have had longer than two week