Surrender Form - Dog Shelter - Franklin County Page 2
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1
2How many hours can he/she “hold it”? _____________
Does your dog have accidents in the house? (
) Yes
(
) No
How often does your dog have accidents in the house?
(
) Never
(
) Daily
(
) 1 - 3 x week
(
) 1 - 3 x mo
DOG’S ACTIVITIES
What toys does your dog like?
(
) Balls
(
) Kongs (
) Frisbees
(
) Squeaky toys (
) Other: ___________
What is your dog’s favorite game?
(
) Fetch
(
) Tug
(
) Chase
(
) Wrestling
(
) Other: ___________
Has your dog had any training?
(
) Yes, at home
(
) Yes, with a trainer/class
(
) None
Name of trainer or place where class was taken: _________________________________________________________________
What commands does your dog know? (
) Sit
(
) Down
(
) Stay
(
) Come
(
) Heel
(
) Give paw/shake
(
) Others: _________________________________________
Where does your dog sleep? __________________________________________________________________________________
Is your dog allowed on furniture?
(
) Yes
(
) No
Does your dog enjoy car rides?
(
) Yes
(
) No
FEEDING AND VET CARE
What brand of food does your dog eat? __________________________________ What type? (
) Dry (
) Wet (
) Mixed
Who is your dog’s veterinarian? _______________________________________
Date of last visit? ______________________
Does your dog need to be muzzled at the veterinarian? ____________________________________________________________
Does your dog have any past or present medical conditions? _______________________________________________________
Is your dog currently on any medications or special diets? _________________________________________________________
MORE HELPFUL INFORMATION
This dog would do well in a home with… (check all that apply)
(
) No kids
(
) Kids over 5
(
) Teenagers
(
) Kids of any age
(
) With dogs
(
) No other dogs
(
) With cats
(
) No cats
(
) Many visitors
(
) Few visitors
(
) No visitors
(
) Someone home mornings and evenings
(
) Someone home all day
(
) Someone home most of the day
Please use the space below for any additional information you would like to share about your dog.
(e.g. best qualities, bad habits, etc.)
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
To the best of my knowledge and belief:
(
) This dog has NOT bitten any person within the last ten days
(
) This dog has bitten any person within the last 10 days
If so, level of bite:
(
) air snap
(
) red mark
(
) puncture
(If it was a puncture or a red mark, a bite report must be filled out)
As the owner of the dog described in this surrender form, or duly authorized agent thereof, I hereby relinquish and transfer ownership of
this animal to the Franklin County Department of Animal Care and Control (FCACC). I understand that the FCACC will evaluate the
dog’s age, temperament, and health, and will take the most appropriate course of action with respect to its disposition. These
dispositions include adoption, euthanasia, or transfer of this animal to another facility. All possible attempts will be made to place
acceptable dogs into new homes.
Signature of owner: X______________________________________________
Date: ________ / _______ / _______
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