Owner Surrender Form


    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 :


    Is your dog spayed/neutered?


    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?


    If yes, please provide license number and issuing city

    Has a complaint ever been filed with animal services regarding this dog?


    *If yes, please provide details:

    Does your dog have any medical/health issues?


    *If yes, please provide details:

    Is this dog current on vaccinations?


    Please provide the name and phone number of your veterinarian:

    Has your dog nipped, mouthed, bruised or scratched with its teeth?


    *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?


    Does your dog chew when left alone?


    Does your dog have experience with other dogs, cats and/or children?


    *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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