First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

What is the best time for us to call you? (choose all that apply)

What number do you prefer we call you at?
Choose one: Home Phone Work Phone Cell Phone

Dog's Name?*

Breed and/or physical description*

Colour*

Dog's Gender*

Dog's Date of Birth (year / month / day)

OR ... Dog's approximate age

Dog's weight*

Has the dog been spayed or neutered*

Is the dog microchipped?*

If the dog is microchipped, please provide the microchip company and the microchip number.

Is the dog up to date on vaccinations?

If the dog is not up to date on vaccinations, please explain why.

Can you provide the dog’s veterinary history? *

If you cannot provide the dog’s veterinary history, please explain.

Name and phone number of veterinarian

What is the reason you wish to surrender the dog?*

Does your dog have any health issues? If so, please explain.*

Has your dog ever had surgery? if yes, please tell us what the surgery was for?*

Do you currently share your life with other animals?*

Tell us about your other animals, including type (dog, cat, bird), breed, age and any relevant character traits. (particularly, let us know if they are comfortable around dogs)

Is your dog:

House Trained?*

Crate trained?*

Leash trained?*

Does the dog:

Have separation anxiety?*

Bark uncontrollably in the house?*

Bark uncontrollably in the back yard?*

Need to be crated or confined when left alone?*

Chew furniture or household items?*

Jump on furniture?*

Jump over fences?*

Steal food off the kitchen counter?*

Steal food out of the garbage?

Have your neighbours or animal control complained about your dog? *

If your neighbours or animal control have complained about your dog, please explain.

Does your dog behave in the car?*

If the dog does not behave in the car, please explain.

Is there anything else we should know about how your dog behaves in the house?

Has the dog bitten or nipped anyone?*

If the dog has bitten or nipped anyone, please provide the details.

Who lives in your home?

Number of Adults

Number of children under 5

Number of children between 5 and 10

Number of children between 11 and 18

In general, what is the dog's reaction to children?*

When playing, is the dog overly rough or mouthy?*

If you answered yes, please explain:

Does the dog guard food, toys, or other items?*

If you answered yes, please explain the guarding issues.

How does the dog react when scared?

How does the dog behave with cats?*

How does the dog behave with other dogs in the house?*

Does the dog guard good, toys or other items from other dogs?

If the dog does guard items from other dogs, please provide details.

In general, does your dog play well with other dogs? Please explain.*

When on leash, does your dog greet other dogs politely? Please explain.

Does your dog behave while being groomed? Please explain.*

What kind of food does your dog eat?
Choose all that apply: Canned Kibble Other Raw Semi-Moist

If you selected "other" type of food, please explain.

What brand of dog food do you feed?*

How much food do you feed per day?*

Where did you get your dog?*

If from a breeder or a rescue, please let us know the name and contact information.

What is the dog's best quality?

What is the dog's worst quality?

Is there anything else you think we should know?

Thank you for taking the time to fill out this surrender application. All of the above information will go a long way to ensuring your dog will be happy and well cared for in the future. If SPIN agrees to accept your dog, we will next ask you to complete an owner surrender document that transfers ownership.

At the time of physical handover, could you please bring your dog’s medical history and any personal items that you wish to donate?

SPIN does not require a surrender fee. However, any monetary donation you wish to consider towards the care of your dog while he or she is with us is gratefully accepted.

If you have any questions or concerns, please do not hesitate to contact us.

To submit your form, click the "Submit" button below ONCE. After clicking ONCE, please wait for the submission confirmation box to appear. If the system is busy, this can be a bit slow to appear. After submission, you will also be sent an automatic confirmation email that your form was received.