Dog Re-homing Form

First Name

Last Name

Street Number

Unit Number (if applicable)

Street Name

City

Postal Code

Email Address

Phone Number

Your Dog's Name

Breed

Dog's Age

Colour

Sex Sex Male Female

Spayed or Neutered Spayed or Neutered Yes No

Reason why you wish to surrender (please be as specific as possible)

Microchipped Microchipped Yes No

Please describe all behavioural issues

How long have you owned the dog?

Where did you get the dog?

How is the dog with strangers?

How is the dog with children?

Has the dog ever bitten anyone? Has the dog ever bitten anyone? Yes No

Is the dog house trained? Is the dog house trained? Yes No

Is the dog crate trained? Is the dog crate trained? Yes No

What type of food do you feed your dog?

Vet Clinic Name

Last vet visit?

When was the dog’s last vaccination?

Health Issues?