OWNER SURRENDER Owner Surrender Owner First Name * Owner Last Name * Street Address * City, State, Zip * Home Phone * Cell Phone Email Address * Drivers License Number , State * Dog's Name * Dog's Gender Dog's Breed (If Known) What Is The Reason For This Surrender? * Is The Dog Spayed or Neutered? * Yes No Unsure Is The Dog Up To Date On All Vaccinations? * Yes No Unsure What veterinarian was used for this Dog? (Name and Phone number) * Please Describe Any Known Health Problems Or Injuries How Did You Acquire This Animal? * Has This Dog Ever Shown Any Aggression Towards Humans? * Yes No Unsure If Yes, Please Describe The Aggressive Beahviors Has This Dog Ever Bitten A Human? * Yes No Unsure If Yes, Please Give Full Details Of The Biting Incident Has The Dog Shown Aggression Towards Other Animals? * Yes No Unsure This Animal Been Around & Shown No Aggression towards (Do Not Check If You Are Unsure): Other Dogs Cats Small Children Older Children Other Small Animals Is This Animal House Trained? Yes No Unsure Have You Ever Surrendered an Animal Before? * Yes No If Yes, To Whom Was it Surrendered? What kind of food was given to this dog? (brand, wet, dry) * What type of routine is this dog used to? (use of crate, run free, etc) * I certify that I am the owner of this dog, and by completing and signing this surrender form I do hereby transfer all rights, title and ownership of this dog to Russell Rescue of TN. * Clear Date Time 121234567891011 : 0030 AMPM Text Submit If you are human, leave this field blank.
