Owner Surrender Intake Form - Dog (Page 2 of 2) in pdf

BEHAVIORAL ATTRIBUTES

Energy level best described? Low_____ Moderate_____ High_____ Hyperactive_____

Loves everyone?_____________ Sweet and Playful?_________ Calm?_____Shy

and/or fearful of strangers?______ Snappy?______ Has shown aggression?___ If so,

explain_____________________________________________________Digger?____

“Escape Artist”?________Destructive? If yes, how______________________________

Barks or howls frequently?___________________ Jumps up on people?_____________

Please circle all behaviors that describe your pet: Friendly, Gentle, Noisy, Aggressive,

Obedient, shy, calm, stubborn, craves attention, anxious to please, affectionate

Please explain any negative behavior traits_____________________________________

_______________________________________________________________________

Does your pet get along with children? _____What ages : 1 to 5yrs____ 5 to 10___ Not

Suited for children_________Why_______________________________

All ages_______ Cats________ Other dogs______ Strangers____________

What activities does your pet enjoy most? Swimming,

fetching

Frisbee, Walks

running loose in back yard or inside a fenced in dog park, “Tug of War” playing

with other dogs ? Other activities______________________________________

Anything unique or special about your pet that you might want to tell us?_________

____________________________________________________________________

What is the main reason you want to find a new home for your

pet?______________________________________________________

__________________________________________________________

What do you consider an ideal home for your pet?

_____________________________________________________________

If you are having a behavior problem with your pet, would you consider

keeping your pet if we could help you with training or any other

inconvenience you feel your pet is causing in your home right now?_______

Signed-Current Owner of

Dog/Assignor______________________________ Date:___________

Signed-Co-owner (if applicable)________________Date:__________

Owner Surrender Intake Form - Dog Page 2