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Surrender Request Form

Owner Information

First Name

Last Name

Email

Phone

Where are you located?

Why are you surrendering your dog?

Do you have other pets in your household?

Yes

No

If yes, please list other pets.

Dog Information

Dog's Name

Breed

Dog's Age

Weight

Sex

Spayed

Neutered

Unaltered

Is your dog up to date on vaccines?

Yes

No

How long have you owned your dog?

Where did you get your dog?

Is your pup dog friendly?

Yes

No

Please explain

Is your dog people friendly?

Yes

No

Please explain

Is your dog kid friendly?

Yes

No

Please explain

Is your dog cat friendly?

Yes

No

Please explain

Is your dog house trained?

Yes

No

Please explain

Is your dog crate trained?

Yes

No

Please explain

What is your dog's temperament?

Submissive

Dominant

Please explain

Does your dog have any behavioral issues?

Has your dog ever bitten another dog or human?

Yes

No

Please explain

I understand that filling out this form does not mean Live Free Animal Rescue will take my dog into the rescue. Live Free Animal Rescue will be in contact within 1 week to go over this information and set up an evaluation to determine if they can take my dog in.

Your Signature

We will be in contact within 7 days!

Contact

Pelham NH

Tel: 603-809-5456

livefreerescue@gmail.com

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