Doberman Underground Owner Surrender Form

Name: *

Street Address:
*

City: *

State: *

Zip Code: *

Mailing Address (if different than Street address):

Email Address: *

Home Phone #: *

Cell Phone #: *

Name of Dog *

Sex of Dog *

Age of Dog *

When did you acquire this dog (month and year)? *

How did you acquire this dog? *

Can you provide a photo of the dog? *

Please upload picture(s). *

Reason for surrendering dog to rescue? Please be specific. *

When will this dog need to come to rescue? * +

Will you transport this dog to us? *

This dog is a (breed): *

Color *

Ear Style: *

Tail *

Has this dog been spayed/neutered? *

Does this dog live inside or outside? *

Is dog house trained? *

Does the dog know any commands? *

What food has the dog been eating? *

How many times per day is the dog fed? Amount? *

Has this dog been seen by a veterinarian? Name, Phone Number: *

Is this dog? *

No

I will get the dog's vetting updated

Up to date on vaccines

Tested for heart worm

Used for breeding

Is the dog on any medications? *

Does this dog have any medical conditions? Please give detailed list if yes: *

Does the dog have any food, medicine, or environmental allergies? *

Has this dog had any surgeries other than spay/neuter? *

Is this dog good with? *

Has this dog ever bitten a human? *

Has this dog bitten another animal? *

Behavioral Issues: *

Barks Excessively

Jumps over fences

Digs

Runs away

Is aggressive toward humans or animals

Guards food

Guards toys

Kills cats

Breaks through invisible fencing

Chases moving objects

Chews

High Prey Drive

No known behavioral issues

Please list any negative traits for this dog not previously covered: *

Please list any positive traits for this dog not previously covered: *

Does this dog have any fears of? *

How did you find Doberman Underground? *

By entering your name in the box below you agree that all of the information in this form is true and correct to the best of your knowledge: *

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Today's Date: * +