Owner Surrender Form ALL FIELDS ARE REQUIRED Your First Name : Your Last Name : Street Address : Street Address 2 : City : State : ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY 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. Check Here