EmailMe Form - Lab Rescue OK Inc - Application to SURRENDER

Lab Rescue Surrender Form

Have you sent us a picture of the dog at photos@labrescue.net?
(surrender applications that do not have pics will not be reviewed) *

Yes

No

Name of Dog *

Use formal Name of dog here

Name of Person Surrendering: *

First Last

Name of Person Surrendering:

First Last

Address of Person Surrendering *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone of Person Surrendering: *

### - ### - ####

Email of Person Surrendering *

Confirm Email

Have you tried to contact the dog's breeder? Reputable breeders always take responsibility for the dogs they produce and usually want their dogs back if you cannot keep it, no matter what the age of the dog is now *

Yes

No

Breeder Name and Phone#

Reason for not returning to Breeder:

Did you adopt this dog from us? *

If yes, what was the dog's Lab Rescue name?

Did you adopt this dog from a different rescue organization? *

If adopted from a different rescue, which one was it?

Did the dog come from somewhere besides us or another rescue organization? *

If yes, where did the dog come from?

Breed of Dog *

If mixed or other breed describe here:

Color of Dog *

Gender of Dog: *

Weight of Dog: *

Is dog spayed or neutered? *

If not spayed/neutered, why?

Age of dog: *

Age of dog at Purchase/Acquistion: *

If dog is a stray, how long have you had the dog in your possession?

Why are you unable to keep the dog? *

Are you willing to allow a Lab Rescue OK Representative come meet your dog and perform an evaluation of temperament? *

Current Family's Ages (include children's ages as well) *

Do you have other animals? If so, Please list their type, gender, age here: *

Describe the Dog's General Temperament: *

Does your dog LIKE other dogs? *

Does your dog LIKE cats? *

Does your dog LIKE Children? *

Does your dog like Car Rides? *

Does your dog like baths? *

Does your dog like being brushed/groomed? *

Does your dog like nails trimmed? *

Does your dog like Water (swimming)? *

Does your dog like Strangers? *

Please Elaborate dog's on Likes/Dislikes here:

Is your dog? *

Housebroken

Crate Trained

Obedience Trained

Food Aggressive (or any other resource guarding) towards Humans

Food Aggressive (or any other resource guarding) towards other animals/dogs

Other/Unknown

Check all That apply

If dog is obedience trained, when and where? *

Does your dog *

Can you leave him/her Unattended in the house for long periods of time without him/her damaging anything or having accidents? *

Yes

No

Don't know

What's your current household activity level? *

Quiet

Active

Very Active

Can/will your dog jump a: *

Short (3ft Fence)

Tall (6ft Fence)

Does not try to get out of a fence

Is the dog currently on Heartworm Preventative? *

Yes

No

I don't know

Name/Type of Heartworm Preventative: *

When was the last Heartworm Test performed?

NOTE: If your dog is NOT on heartworm preventative, we will need proof of a Heartworm Antigen Test that has been performed in the past 6 months showing a NEGATIVE result. *

Is this dog Microchipped? *

Yes, please see chip ID # below

No

I don't know

MICROCHIP ID#

VET INFORMATION

Do you have a Veterinarian? *

If yes, Name of Vet?

Phone Number of Vet

### - ### - ####

UPLOAD EXISTING VETTING DOCUMENTS HERE:

Does your dog have any medical issues or injuries we should know about? Please explain: *

Date of Most recent Rabies Vaccine: *

Date of Most recent DA2PP Vaccine: *

Date of Most recent Bordatella Vaccine: *

What type of Food does this dog eat? *

How many meals does this dog eat per day? *

Exercise/Potty Schedule? *

How does this dog let you know it's time to go outside? *

Where is this dog kept during the day? *

Where is this dog kept at night? *

Has this dog ever snarled or snapped? (Be honest) *

Has this dog ever bitten a person or another dog? (Be honest) *

Has this dog ever shown fear of strangers, thunderstorms, etc? *

Can you make a donation towards the dog's care? *

What is your time frame for surrendering the dog? *

When do you need the dog to come into the program?

Additional Comments

I/We agree and understand that IF Lab Rescue OK, Inc. takes this dog/animal into the program that it will, at that point, be under the care, ownership and sole discretion of Lab Rescue OK, Inc. to find it a home as we see fit. *

I agree

DATED: *

MM / DD / YYYY