REHOMING/SURRENDER

Name(Required)

First Last

Animal(s) Name(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Breeder's Name

First Last

Breeder's Phone

Breeder's Email

Breeder's Address

Street Address Address Line 2 City State ZIP Code

Animal(s) DOB/Age

Sex

Color/Markings

Weight

DOG

Shots done

Date

Last Heartworm check

Date

Results

Positive

Negative

Heartworm Preventive Brand

Date

Flea/Tick Preventive Brand

Date

Spayed/Neutered?

Yes

CAT

Shots Done

Date

FeVL/FeXX Tested

Results

Positive

Negative

Spayed/Neutered?

Yes

Vet Name

Vet Phone

Has your animal(s) lived outside mainly or inside or both?

Housetrained

Signal used to go outside

Crate trained

Obedience trained

Bad habits (fence jumping, digging, barking, chasing cars, chasing cats, chewing)

Ever been used for breeding

Has dog bitten anyone? If yes, please provide circumstances

Things the animal(s) likes to do

Is the animal(s) afraid of anyone/anything in particular?

Likes other dogs?

Likes other cats?

Likes children?

Likes adults? Prefers men or women?

Does dog have any known health problems?

Reason for surrendering

Feeding schedule (Time/Brand/Amount): Any treats the animal(s) like

I, ______________________________ (pet owners name) certify that I am the owner of the animal described above. I further certify this dog is clear of heartworms, is on preventive and that all shots (DHLPP & Rabies) are up to date. It is my understanding that Angel Paws Advocates will do what is best for the animal(s).

Name(Required)

First Last

Signature

Date

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Angel Paws Advocates would appreciate a donation to help defray costs of placement.