Found/Surrender Dog Application

First Name*
Last Name*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite or Unit Number
City*
State*
ZIP
Country
- Phone*
History
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Dog Default Status: Submitted
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Are you the legal owner of the dog?*
- Yes
- No
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Please Explain*
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Are you the only owner of the dog?*
- Yes
- No
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Please Provide Other Owner's Name:
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Other Owner's Phone #
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When Did You Get The Dog? (approximate if necessary)
Month
Day
Year
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How Long Have You Had This Dog?
- How Was The Dog Obtained?
- Please Explain
- Breeder's Name (if Known)
- Have They Been Notified?
  - Yes
  - No
- Why Not?
- Owner of Dog's Sire (If Known)
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  Why Are You Giving Up The Dog?*
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  Please Explain
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  Please Explain The Behavior Issues
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  Please Explain The Health Issues
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  Please Explain Care Needed
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How Many Homes Has This Dog Had?
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Veterinarian Information
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Do You Have a Veterinarian?
- Yes
- No
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Name of Clinic
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Name of Vet
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Street Address
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Suite or Unit Number
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City
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State
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ZIP
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Phone
- Dog's Name*
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  Dog's Registered Name (If Purebred)
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  Dog's Registration Number (If Known)
- Primary Breed*
- Breed Name
- Secondary Breed
- Breed Name
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Primary Color
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Which Color?*
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Secondary Color
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Which Color?*
Gender*
- Male
- Female
Dog's Date of Birth (If Known)
MM slash DD slash YYYY
Weight*
Energy Level*
- Good With Kids?*
- Good With Dogs?*
- Please Explain*
Good With Cats?*
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Good With Small Animals?
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Good With Livestock?
Is Dog Trained?
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Are There Any Special Needs?
- Yes
- No
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What Special Needs?
Select All That Apply
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Description of the Dog
Featured Image
Accepted file types: jpg, jpeg, png, gif.
750 Wide x 750 High in Pixels
Additional Photos of The Dog
Drop files here or

Accepted file types: jpg, gif, png, jpeg, Max. file size: 1 MB, Max. files: 3.
Upload Photos of the Dog (minimum of 3 - include one head shot, one full body) and 750 Wide x 750 High in Pixels
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Eating
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How Often Is The Dog Fed?
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Does Dog Eat Wet Or Dry Food (Or Both)?
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What Type Of Wet Food Does The Dog Eat?*
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How Much Wet Food Does The Dog Eat?*
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What Type Of Dry Food Does The Dog Eat?*
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How Much Dry Food Does The Dog Eat?*
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What Type Of Wet Food Does The Dog Eat?*
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How Much Wet Food Does The Dog Eat?*
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What Type Of Dry Food Does The Dog Eat?*
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How Much Dry Food Does The Dog Eat?*
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Is Dog A Good Eater?
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Does Dog Steal Food From Table/Counters?
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Sleeping
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Which Room Does Dog Normally Sleep In At Night?
Select All That Apply
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Please Describe*
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What Does Dog Use For A Bed?
Select All That Apply
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Please Describe*
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Is Dog Allowed On Furniture?
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Grooming
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How Often is Dog Bathed?
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Does Dog Mind Baths/Grooming
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Does Dog Mind Toenails Clipped
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Does Dog Mind Ears Cleaned
Dog & People
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Is Dog A One Person Dog?
Does Dog Like Men?
Please Explain*
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Please Explain*
- Does Dog Like Women?
- Please Explain*
- Please Explain*
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  Does Dog Prefer Men?
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  Please Explain*
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Does Dog Prefer Women?
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Please Explain*
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Does Dog Jump On People?
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Is Dog Friendly With Strangers?
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Is Dog Good With Other Animals?
Is Dog Good With Kids?
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Does Dog Like Kids Under 6?
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Does Dog Like Kids 6-10?
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Does Dog Like Kids Over 10?
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Dog's Temperament
Select All That Apply
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How Are Dog's Social Skills?
Select All That Apply
Training
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Does Dog Know Basic Commands?
Select All That Apply
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Is Dog Obedience Trained?
Is Dog House Trained?
Is Dog Crate Trained?
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Is Dog Leash Trained?
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How Does Dog React on Walks?
Select All That Apply
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Does Dog Know How To Use A Doggie Door?
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Does Dog Have Occasional Accidents?
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Does Dog Tear/Chew Furniture Or Carpet?
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Can Dog Be Left Uncrated?
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Does Dog Dig?
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Does Dog Know How To Swim?
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Does Dog Jump Fences?
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Does Dog Escape?
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Does Dog Ride Well In The Car?
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Barking
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Does Dog Bark At Noises?
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Does Dog Bark At Someone At The Door?
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Does Dog Bark Excessively?
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Fear & Agression
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Does Dog Exhibit Submissive Behavior?
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Please Describe*
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Please Describe*
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Does Dog Exhibit Aggressive Behavior?
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Please Describe*
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Please Describe*
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Does Dog Guard Food?
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Please Describe*
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Please Describe*
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Does Dog Guard Other Resources (Toys, People, etc.)?
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Please Describe*
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Please Describe*
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Is Dog Shy?
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Please Describe*
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Please Describe*
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Is Dog Fearful Of Strange Noises/Storms?
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Please Describe*
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Please Describe*
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Has Dog Ever Bitten Anyone?
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Please Explain*
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Has Dog Otherwise Attacked Anyone?
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Please Explain*
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Has Dog Attacked Another Animal (Dog, Cat or Other)?
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Please Explain*
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Is there anything else you would like to let us know about the dog's disposition?
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Medical: MicroChip Information
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Is Dog MicroChipped
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Are you prepared to transfer registration to {RescueName} on or prior to the surrender of the dog?
- Yes
- No
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MicroChip Company (If Known)?
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Other Company
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MicroChip Number (If Known)?
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Does Dog Have a Tattoo?
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Please Upload Photo*
Drop files here or

Accepted file types: jpg, gif, png, jpeg, Max. file size: 5 MB, Max. files: 3.
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Please Describe*
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Medical: Medical Conditions
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Add Current Medical Conditions (N Number)
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Add Past Medical Conditions (N Number)
Medical: Status
Is Dog Spayed Or Neutered?
- Yes
- No
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Date:*
Month
Day
Year
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Expected Date*
Month
Day
Year
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Please Explain Why Not*
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Medical: Dental Conditions
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Add Current Dental Conditions (N Number)
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Add Past Dental Conditions (N Number)
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Medical: Known Allergies
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Add Allergies (N Number)
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Medical: Medicines
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Add Medications (N Number)
Notes
Is there anything else you would like to let us know?
In your opinion, what would be the best type of home situation for this dog?
This contract is between (current owner) and Summit's Sanctuary (SSAR) (New Owners described above, and is made for the benefit and protection of both the current owner and the new owners as well as the welfare of the dog. The current owner herby relinquishes all claim of ownership of, and responsibility for, the above mentioned dog. No guarantee of health has been given to new owner by the current owner, and the new owner agrees to hold the current owner harmless for any veterinary or other expenditures that may arise after this date. All transactions relating to the surrender of this dog shall be held confidential by Summit's Sanctuary. This agreement shall be construed under that laws of, and enforced only in the courts of, Alabama. In signing this agreement, the sigher or signers of this document agree to its terms and shall reimburse to Summits Sanctuary the reasonable legal fees and costs associated with any legal action necessary to enforce this agreement. This means that any lawsuit filed in relation to this contract must be filed and tried within Alabama, regardless of the geographic location of the other party. Current owner signature. I agree and submit that all of the above information is true to the best of my knowledge.*
- Yes
Signature
Name
This field is for validation purposes and should be left unchanged.

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Found/Surrender Dog Application

History

Veterinarian Information

Eating

Sleeping

Grooming

Dog & People

Training

Barking

Fear & Agression

Medical: MicroChip Information

Medical: Medical Conditions

Medical: Status

Medical: Dental Conditions

Medical: Known Allergies

Medical: Medicines

Notes

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