Owner Surrender Form

    ALL FIELDS ARE REQUIRED

    Your First Name :
    Your Last Name :
    Street Address :
    Street Address 2 :
    City :
    State :
    Zip Code :
    Your Email :
    Phone :

    Dog Information

    Dog's Name :
    Approximate age or exact birth date if known :
    Gender :
    MaleFemale
    Is your dog spayed/neutered?
    YesNo
    Breed (Purebred, Mixed) :
    How long have you had this dog?
    Where did you get her/him?
    Please tell us why you need to give up your dog :
    Is your dog licensed?
    YesNo
    If yes, please provide license number and issuing city
    Has a complaint ever been filed with animal services regarding this dog?
    YesNo
    *If yes, please provide details:
    Does your dog have any medical/health issues?
    YesNo
    *If yes, please provide details:
    Is this dog current on vaccinations?
    YesNo
    Please provide the name and phone number of your veterinarian:
    Has your dog nipped, mouthed, bruised or scratched with its teeth?
    YesNo
    *If yes, please provide details:
    Where does your dog stay when you leave her/him alone at home?
    Do you use, or have you ever used, a dog crate for this dog?
    YesNo
    Does your dog chew when left alone?
    YesNo
    Does your dog have experience with other dogs, cats and/or children?
    YesNo
    *If yes, please provide ages and your dogs behavior with the children.

    Thank you for completing the surrender profile. This certifies you are voluntarily surrendering your Shar Pei to Florida Shar-Pei Rescue and have no recourse in where she/he is fostered or adopted to. Florida Shar-Pei Rescue survives through donations made to our Rescue, and we would appreciate a donation to accept your surrender.

    I understand that by filling out this form I am submitting my dog for consideration into the rescue and it is not a guarantee that FSPR will take my dog.

    Please check this box to acknowledge above.
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