SURRENDER QUESTIONNAIRE APPLICANT CONTACT INFORMATION
Applicant(s)
Address
City
Zip Code
Phone Number
Email (required)
DOG INFORMATION
Dog's Name
Age or Date of Birth
Current Weight in lbs.
Gender —Please choose an option—MaleFemale
Is the dog spayed or neutered? —Please choose an option—NoYes
Please describe the dog's Color/Markings
How long have you owned this dog?
Where did you obtain this dog? (Source or breeder's name)
Why are you wishing to surrender this dog?
DOG HEALTH/MEDICAL BACKGROUND
Your Veterinarian/Veterinary Hospital
Date of last exam
Date of last booster shots
Is the dog on heartworm preventative? —Please choose an option—NoYes
Is the dog on a flea and/or tick control? —Please choose an option—NoYes
Does the dog have any known allergies? NoYes If Yes, Please Explain:
Has the dog ever had a long term illness or required surgery in the past? NoYes If Yes, Please Explain:
Is the dog on any special medications? NoYes If Yes, Please Explain:
ABOUT YOUR DOG
What type of dog food do you feed?
How much per day?
Has the dog ever bitten a person hard enough to break the skin? —Please choose an option—NoYes Please explain the situation in which the bite incident occurred.
Tell us about the dog's favorite toys and games
Has the dog attended any type of training classes? —Please choose an option—NoYes If Yes, Please Explain
What is the energy level of the dog? —Please choose an option—Low - Couch PotatoMedium - Keeps pace with me during walks, likes to playHigh - Keeps pace with me running, then on to the dog park, go go go
Is the dog ever destructive(i.e. chewing, digging, etc)? NoYes If Yes, Please Explain
Does the dog bark a lot? NoYes If Yes, Please Explain
Has the dog been around small children? NoYes How does the dog do with them?
Did the dog live with other dogs? NoYes How does the dog interact with them?
Has the dog lived with cats? NoYes If Yes, How does the dog interact with them?
Has the dog had exposure to dogs outside the home? NoYes If Yes, How does the dog react?
Does the dog have any issues going up and down steps/stairs? NoYes If Yes, Please Explain
Does your dog socialize with other dogs outside of its own family? Examples: dog parks, dog meetup groups, dog clubs, dog friendly restaurants, other venues where dogs are allowed and able to be social
Where does the dog sleep at night?
Additional questions about your dog
Is the dog aggressive with people over food or treats? NoYesN/A
Is the dog aggressive with people over toys? NoYesN/A
Is the dog aggressive with other pets over food or treats? NoYesN/A
Is the dog aggressive with other pets over toys? NoYesN/A
Is the dog house trained? NoYesN/A
Is the dog crate trained? NoYesN/A
Is the dog accustomed to walking on a leash? NoYesN/A
Is the dog frightened by thunderstorms? NoYesN/A
Is the dog a good traveler? NoYesN/A
Is the dog usually crated when riding in a car? NoYesN/A
Some dogs have sensitive areas i.e. old injuries, arthritis, etc. that puts the dog in pain when picked up. Others do not have trust that allows them to be picked up. Can your dog be picked up? If not, please describe in detail the circumstances.
Nail trimming brings out the best or worst in our dogs. Is nail trimming a multi-person event and a muzzle is required? Is nail trimming a tranquil, spa-like routine at your house or something in between. Please describe what nail trimming is like with your dog.
How would you describe the dog's personality, temperament and behavior?
Any additional information you would like to add?
Before a decision is made, would you be willing to allow a member of Sunshine Corgi Rescue visit with you and the dog listed in this form? NoYes, I would allow a visit by SCR.
PLEASE INCLUDE TWO UPDATED DIGITAL PICTURES OF THE DOG. Ensure the entire dog can be seen including body, legs and face. We use these pictures to send out to the potential adopters.
Whole body picture (2mb max file size)
2nd Picture upload (Optional) (2mb max file size)
