Sundance CRS
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Pawtners & Friends
Surrender Form for Sundance CRS
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Indicates required field
Full name
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First
Last
Best phone number to reach you at:
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
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Name of the dog
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Date of Birth or Approximate Age:
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Breed and colour of dog
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Sex of dog
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Female
Male
Is the dog:
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spayed
neutered
unaltered
Are the vaccinations up to date?
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Yes
No
Not sure
Date of last Veterinary visit
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I agree to hand over all veterinary records, including vaccination and spay/neuter records, for the dog above to Sundance CRS, at the time of surrender.
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I agree and have copies
I agree but do not have copies
Date of Surgery
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Microchip # or Tattoo #
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Name of company for Microchip
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Name of Veterinary Clinic
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Phone Number of Veterinary Clinic
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Where and when did you get the dog?
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Describe the activity level of the dog
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Is the dog good with:
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Other dogs?
Cats?
Other animals?
Children (infant to 6 years)
Children (6 to 12 years)
Children (12 years and older)
Strangers?
Please check the boxes that apply
Comfortable with Collar/harness and leash
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Yes
No
Needs work
House trained
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yes
no
needs work
Crate Trained
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Yes
no
needs work
Please explain why you are surrendering the dog to Sundance CRS and any behaviours we should be aware of.
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Does the dog display any of these behaviours?
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Digger
Destructive Chewer
Separation Anixiey
Excessive Barking
Aggressive Behaviours
Has this dog ever bitten a human?
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yes
no
Has this dog ever bitten a dog or cat?
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Yes
No
Where does your dog stay during the day? Sleep at night? And how many hours is it alone during the day?
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I/We state that I/We are the sole owners of the above described dog and that no other parties have a legal interest in this dog. I/We relinquish all rights, interest, and ownership of above dog to Sundance Canine Rescue and hereby relinquish all claims to said dog. I/W e understand that this surrender is irrevocable and ownership of the dog is now relinquished to Sundance Canine Rescue. I/We certify that to the best of my/our knowledge that above dog has not bitten any human or animal and there are no claims as such from this. I/We agree to hold the Sundance Canine Rescue and any and all persons directly or indirectly involved with the surrender and future adoption of this dog harmless and indemnify the preceding against any and all claims, actions, demands, or liability of any kind whatsoever arising as a result or in connection with the above described dog. I/We further understand and agree that I/We will receive no money or other compensation as a result of this surrender. The
surrender fee of $150.00
for a dog and it will be a donation made to Sundance Canine Rescue, further more does not constitute a sale and that this donation will be used to benefit future Sundance Canine Rescues dogs.
By submitting this form I, certify that the information given is true and correct.
Name
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First
Last
Date of Surrender
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Submit
