EmailMe Form - Surrender Application

Name *

First Last

Address *

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

Phone *

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

Another number where you can be reached

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

Email

Pet Information

Name of Pet *

If you are applying to surrender more than one dog, please fill out an application for each. Thank you.

Breed *

Age *

Sex *

Male

Female

Altered *

Spayed

Neutered

Not Altered

Color *

Approximate Weight *

Current Vaccinations (Check all that apply) *

Rabies (dog and cats)

DHPP/Distemper/Parvo (dogs only)

Bordatella/Kennel Cough (dogs only)

Lyme (dogs only)

FVRCP (cats only)

FeLV Vaccine (cats only)

Not Vaccinated

If vaccinations are up to date, you will be asked to submit proof at the time of surrender.

Name of Veterinarian
(If unknown, put NA) *

Veterinarian Phone

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

Does your pet have any known health issues? *

Yes

No

If yes, please explain.

Is your pet taking medication or supplements? *

Yes

No

If yes, please explain.

Please explain, in detail, why you wish to surrender your pet to Tanner's PAWS. *

Is there anything we can do to help you so that you do not have to rehome your pet? *

Yes

No

If yes, please explain.

Household Information

Does your pet get along with dogs? *

Yes

No

Unknown

Does your pet get along with cats? *

Yes

No

Unknown

Is your pet friendly with children under the age of 12? *

Yes

No

Unknown

Is your pet friendly with children over the age of 12? *

Yes

No

Unknown

Is your pet friendly with strangers? *

Yes

No

Unknown

Is your pet housebroken? *

Yes

No

Paper Trained

Unknown

Is he or she crate trained? *

Yes

No

Unknown

If yes, please tell us how long your pet is crated throughout the day and/or night.

Does your pet have any behavioral issues that we should know about? *

Yes

No

Unknown

If yes, please explain in detail. Failing to provide us with adequate and honest information will set your pet and the rescue attempt up for failure.

Does your pet have a bite history against other pets? *

Yes

No

If yes, please explain:

Does your pet have a bite history against people? *

Yes

No

If yes, please explain:

Does he or she have food or treat aggression? *

Yes

No

If yes, please explain:

Are there any wonderful, special traits or habits that you would like his/her foster or new family to know about? *

Does your pet have favorite toys or treats? *

I certify that the foregoing representations are true and accurate to my own knowledge, and to those matters of which I do not have direct knowledge, I believe them to be true.

Your initials. *