Surrender Form Please select one of the following * Owner surrender Found/stray How long have you had the dog? * Where did you purchase/obtain/find the dog? * If you found the dog, did you post on the Internet/social media as found? When was the dog posted on Internet/social media as found? Pet Information: Name * Breed Color/description * Gender Age Weight Medical Information: All surrenders must present proof of up-to-date shots with heart worm test Vet used Phone (###) ### #### Spayed/Neutered? Yes No Microchipped? Yes No Is or has been pregnant? Yes No Date of pregnant MM DD YYYY Date of last heartworm test Date of last shots Allergies Surgeries Any other known medical conditions Proof of UTD medical records? * You must show proof of up-to-date on all shots including DHPP, rabies, and. a heart worm test or you will be responsible for a $50 fee for each that we administer. Yes No Behavioral Information: Adult males * Good Bad Unknown Adult females * Good Bad Unknown Teenagers * Good Bad Unknown Children * Good Bad Unknown Cats * Good Bad Unknown Strangers * Good Bad Unknown Other animals * Good Bad Unknown Housebroken? * Yes No Crate trained? * Yes No Has the dog bitten, scratched, or snapped at any human or other dog in the past month? * Yes No If yes, explain and be honest Has the dog been in a fight with another dog in the past month? * Yes No If yes, explain and be honest How many hours a day is the dog alone? * Where does the dog spend the day? * Where does the dog spend the night? * When outside, the dog is (chained, fenced yard, leash walked, etc.) * When left alone inside, the dog will... * When left alone outside, the dog will... * Any destructive behavior inside or outside? * What type of physical activity has the dog been receiving? * Other likes? * Other dislikes? * Please read and check each box to agree to the following * I certify that I am the rightful owner/caregiver/keeper/guardian of the dog this surrender form is the subject of, and no one else has property rights to the dog I certify that I am transferring ownership to Trooper's Treasures and I am surrendering all property rights to the animal I understand that once surrendered, the dog will not be available to be returned unless authorized by Trooper's Treasures owners, which may include going through Trooper's Treasures adoption process including paying the adoption fee Any contact from Trooper's Treasures on the well-being and adoption status of the dog is at the discretion of Trooper's Treasures and not mandatory or guaranteed Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * I wish to have my phone number given to the new adopters so I can see how the dog is doing This is strictly at the discretion of the new owners, not Troopers Treasures Yes No Thank you!
