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Surrender Form

Michigan Standard Poodle Rescue — P.O. Box 1882, Bay City, MI 48707. Please complete this form as thoroughly as possible. The more we know about your dog, the better we can match them with the right adoptive family.

"*" indicates required fields

About You

Your Full Name*

Home Address*

City*

Zip Code*

Email Address*

Work Phone*

Home Phone*

Cell Phone*

Best time to contact you:*

Morning

Afternoon

Evening

Anytime

About the Dog(s) Being Surrendered

How many dogs are you surrendering?*

1

2

3 or more

Dog 1

Dog 1 - Name*

Dog 1 - Breed*

Dog 1 - Age*

Dog 1 - Gender*

Male

Female

Dog 1 - Spayed/Neutered?*

Yes

No

Unknown

Dog 1 - Color/Markings*

Dog 1 - Weight (approximate)*

Dog 2

Dog 2 - Name*

Dog 2 - Breed*

Dog 2 - Age*

Dog 2 - Gender*

Male

Female

Dog 2 - Spayed/Neutered?*

Yes

No

Unknown

Dog 2 - Color/Markings*

Dog 2 - Weight (approximate)*

If surrendering 3 or more dogs, please list additional dogs (Name, Breed, Age, Gender, Spayed/Neutered, Color, Weight):*

Dog History and Background

If surrendering more than one dog, please answer for the dog you have had the longest.

How long have you had the dog(s)?*

How did you acquire the dog(s)?*

Breeder

Rescue/Shelter

Friend or Family

Stray

Other

If Other, please specify how acquired*

Is the dog microchipped?*

Yes

No

Unknown

Microchip Number(s)*

Is the dog currently licensed?*

Yes

No

What does the dog eat? (Brand, amount, how often)*

How much exercise does the dog typically get per day?*

Where does the dog sleep?*

Is the dog housebroken?*

Yes

No

Mostly

Is the dog crate trained?*

Yes

No

Has the dog received any obedience training?*

Yes

No

If yes, what type of training and what commands does the dog know?*

Behavior and Temperament

How does the dog behave with adults?*

Very friendly

Friendly

Reserved/shy

Unpredictable

Fearful

How does the dog behave with children?*

Very friendly

Friendly

Reserved/shy

Unpredictable

No experience with children

How does the dog behave with other dogs?*

Very friendly

Friendly

Selective

Aggressive

No experience with other dogs

How does the dog behave with cats?*

Very friendly

Friendly

Chases

Aggressive

No experience with cats

Has the dog ever bitten or snapped at a person or animal?*

Yes

No

If yes, please describe the incident(s) in detail:*

Does the dog have any of the following behavioral issues? (check all that apply)*

Excessive barking

Destructive chewing

Jumping on people

Pulling on leash

Separation anxiety

Resource guarding

Fear/anxiety

Escaping yard/house

None

Veterinary Information

Current Veterinarian Name/Practice*

Vet Address*

Vet City*

Vet Phone Number*

Is the dog up to date on vaccinations?*

Yes

No

Unknown

Date of last heartworm test*

Is the dog on heartworm prevention?*

Yes

No

Does the dog have any current medical conditions?*

Yes

No

Please describe current medical conditions:*

Does the dog have any known allergies?*

Yes

No

Please describe known allergies:*

Is the dog on any medications? If yes, please list:*

Reason for Surrender

Reason(s) for surrendering (check all that apply):*

Moving and unable to take dog

Allergies

New baby

Financial hardship

Not enough time for the dog

Behavioral issues

Medical issues (dog)

Medical issues (owner)

Divorce/separation

Other

Please describe your reason for surrendering in more detail:*

Have you tried any solutions to keep the dog?*

Yes

No

If yes, what solutions have you tried?*

Have you tried to find a home for the dog yourself?*

Yes

No

Do you have any preferences for the new home? (e.g., no small children, no other dogs, etc.)*

Is there anything else you would like us to know about your dog?*

Acknowledgment

By submitting this form I confirm that the information provided is accurate to the best of my knowledge. I understand that Michigan Standard Poodle Rescue will make every effort to place my dog in a loving home, but cannot guarantee placement.

I confirm the above information is accurate and I understand the terms*

I confirm

Bay City, Michigan | info@michiganstandardpoodlerescue.com | (989) 450-4009

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