Surrender Form Today's Date* Date Format: MM slash DD slash YYYY Name* First Middle Last Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Did you adopt your dog through us?*YesNoPlease tell us how you acquired your dog:*How long has your dog been in your family?*Dog's Name*Dog's Age*Dog's Breed*Male or female?*MaleFemalePlease list the information for the veterinarian who last treated your dog.Veterinarian's NameAddressPhone Number Spayed or Neutered?*YesNoIs your dog up-to-date on vaccinations?*YesNoIf your dog is not up-to-date on vaccinations, please explain why and which, if any, vaccinations they have had and when:*Microchip Number*Tell us about your dog* Kid friendly House trained Good with all dogs Good with male dogs only Good with female dogs only Good with small dogs only Good with large dogs only Good with cats Jumps fences Crate trained Has separation anxiety Walks well on leash Is leash reactive Is fearful of people Has your dog ever bitten anyone?*YesNoPlease explain any and all situations where your dog has bitten a person:*Has your dog ever bitten another dog?*YesNoPlease explain any and all situations where your dog bit another dog:*Why are you surrendering your dog?*How quickly would you like the dog out of your home?*Please upload all of the dog's veterinary records Drop files here or Please upload a clear photo that shows your dog's face: Drop files here or * I certify that I am the legal owner of the above described canine. I surrender all claim of ownership to the above described canine to Big Bones Canine Rescue without recourse. I will make no effort to reclaim the above described canine.*Signature*Date of Birth* Date Format: MM slash DD slash YYYY
