OWNER SURRENDER FORM
NEW SPIRIT AUSSIE RESCUE
PLEASE ANSWER ALL QUESTIONS AS COMPLETELY AS POSSIBLE.
Fields marked with a * are required.
LAST NAME
ADDRESS
CITY
PHONE NUMBER
E-MAIL  *
DOG'S NAME
FIRST NAME
STATE
ZIP
COLOR
AGE   *
DOG'S HEIGHT (at the shoulders)
DOG'S WEIGHT
NAME OF VET
DESCRIBE ANY INJURIES OR KNOWN HEALTH PROBLEMS AND LIST ANY CURRENT MEDICATIONS INCLUDING HEARTWORM PREVENTATIVE.
(If you can't provide vet or requested health information, please explain why here.)
VET'S PHONE NUMBER
ARE YOU THE OWNER?
IF NO, DO YOU HAVE THE AUTHORITY TO ACT AS AGENT FOR THE OWNER?
HOW LONG HAVE YOU OWNED THE DOG?
WHERE DID YOU GET THE DOG?
IF THE DOG WAS BOUGHT FROM A BREEDER, PLEASE GIVE BREEDER'S NAME AND LOCATION IF KNOWN
IS THE DOG REGISTERED (I.E DOES IT HAVE "PAPERS"?
HAS THIS DOG EVER SHOWN AGGRESSION TOWARD PEOPLE INCLUDING BUT NOT LIMITED TO AN INJURY BITE (ONE THAT LEFT BRUISED OR BROKEN SKIN)?   IF YES, PLEASE EXPLAIN.
HAS THIS DOG EVER SHOWN AGRESSION TOWARD OTHER DOG(S)?
IF YES, PLEASE EXPLAIN.
IS THE DOG USED TO A CRATE?
WHAT ARE THE DOG'S FAVORITE ACTIVITIES/TOYS?
NOTE: ALTHOUGH NOT REQUIRED, A SURRENDER DONATION WOULD BE GREATLY APPRECIATED.
I CERTIFY THAT THE INFORMATION GIVEN ABOVE IS TRUE AND COMPLETE TO BEST OF MY ABILITY.

IF YOU LEAVE THIS PAGE BEFORE CLICKING  SUBMIT, YOUR DATA WILL BE LOST.
WHEN YOU HAVE COMPLETED THIS FORM, CLICK  THE SUBMIT BUTTON BELOW AND THE DATA WILL BE SAVED AND TRANSMITTED TO NEW SPIRIT RESCUE.

THANK YOU FOR YOUR INTEREST IN NEW SPIRIT AUSSIE RESCUE.   SOMEONE WILL CONTACT YOU SOON.
IS THE DOG HOUSEBROKEN?
IS THE DOG SPAYED OR NEUTERED?
IS THE DOG UP TO DATE ON SHOTS?
IS THE DOG ON HEARTWORM PREVENTATIVE (I.E HEARTGARD, INTERCEPTOR)?
DATE OF DOG'S LAST VET VISIT IF KNOWN (APPROX)
WHY DO YOU NEED TO RE-HOME THE DOG?
HOW IS THE DOG WITH WOMEN?
HOW IS THE DOG WITH MEN?
HOW IS THE DOG WITH CHILDREN?
HOW IS THE DOG WITH CATS?
WHERE IS THE DOG USED TO SPENDING MOST OF ITS TIME?
HOW DOES THE DOG WALK ON LEASH?
HOW DOES THE DOG RIDE IN A CAR?
HOW IS THE DOG WHEN LEFT LOOSE IN THE HOUSE?
WHAT KIND OF HOME DO YOU THINK WOULD WORK BEST FOR THE DOG?
DOES THE DOG HAVE ANY BAD HABITS SUCH AS JUMPING ON PEOPLE, MARKING, COUNTER SURFING, ETC.?
HOW IS THE DOG WITH VISITORS TO YOUR HOME?
HOW IS THE DOG WITH STRANGERS?
HOW WOULD YOU DESCRIBE THE DOG'S PERSONALITY?
HOW WOULD YOU DESCRIBE THE DOG'S ENERGY LEVEL?
IS THERE ANYTHING ELSE YOU'D LIKE US TO KNOW ABOUT THE DOG?
IF REGISTERED, WHICH REGISTRY?
HOW IS THE DOG WITH OTHER DOGS?
HOW IS THE DOG DURING THURNDERSTORMS OR FIREWORKS?
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YESNO
YESNO
YESNO
YESNODON'T KNOW
YESNODON'T KNOW
YESNO
SHELTERBREEDERRELATIVEFRIENDOTHER
YESNO
AKCASCANSDROTHER
YESNO
EXCELLENTGOODFAIRNERVOUSHOSTILE
EXCELLENTGOODFAIRNERVOUSHOSTILE
EXCELLENTGOODFAIRNERVOUSHOSTILE
EXCELLENTGOODFAIRNERVOUSHOSTILE
EXCELLENTGOODFAIRNERVOUSHOSTILE
EXCELLENTGOODFAIRNERVOUSHOSTILE
LOOSE INDOORSOUTDOORSCRATEDOTHER
EXCELLENTGOODFAIRNERVOUSHOSTILE
WALKS ON A LOOSE LEASHPULLSPULLS REALLY HARDDON'T KNOW
QUIETLYNERVOUSHAPPY BUT NEEDS TO BE RESTRAINED
YESNODON'T KNOW
YESNODON'T KNOW
NO PROBLEMSDESTRUCTIVE
FINENERVOUSTERRIFIED
VERY OUTGOINGFRIENDLYLAID BACKRESERVED SHYNERVOUS
HIGHMEDIUMLOW