Relinquishment Application***Please answer honestly, negative behavioral traits do not automatically disqualify a dog for adoption*** Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Dog's Name Breed Age Weight Is the dog spayed/neutered? Yes No I don't know Does this dog have a microhip? Yes No I don't know Why are you surrendering this dog? Are you or someone you know able to keep this dog until a home can be found? Yes No Are you able to meet potential adopters in a neutral location? Yes No Yes but I need tips on how to introduce my dog to other dogs Has this dog ever bitten anyone? Yes no If yes, when and please explain circumstances If yes, was the incident reported with by-law, animal control or public health? Yes No n/a What Veterinarian does this dog visit? Has this dog seen a veterinarian in the last 12 months? Yes No Has this dog ever had surgery other than spay/neuter? If yes, explain why. Is this dog on any medication? If yes, please list Is this dog eating a prescription diet? If yes, please list. How would you describe this dog's energy level? Couch potato Needs a walk around the block Moderately active Very active How would describe this dog's personality? Check all that apply. Calm Anxious Shy Shy but warms up Aggressive Aloof/independent Affectionate Friendly to strangers Can be wary of strangers Aggressive toward strangers Aggressive with other dogs Only leash aggressive Total lap dog Clingy Is this dog good with the following? If unknown, do not check. Other dogs in the house Other dogs outside the house such as parks Cats Children Pocket pets Livestock Children Women Men How does this dog interact with children? Have experiences with children been positive? If no, please explain. If unknown, answer unknown. Is this dog most comforable with: women men seniors kids loves all people What are some of the dog's dislikes? Are there any quirks or valuable insights that can help us ensure the best match for this dog? Current diet and favorite treats Is the dog housetrained? Yes No Working on it Has the dog been to any obedience training? Yes No What commands does this dog know? Sit Come Stay Down Heel Off Leave it Others Is this dog used to being in a fenced yard? Yes No How does this dog behave on a leash? Calmly and will walk without pulling Excited, pulls moderately Excited but calms down after a while Aggressively, cannot control Unpredictable Fearful, collapses Unknown Is this dog crate trained? Yes No House trained but not crate trained Does this dog display any destructive behaviour? No Yes if left alone for a long time Yes if left alone for a short time Will destroy things no matter what Does this dog bark excessively? No If stimuli present such as someone at the door If bored All or much of the time How is this dog in the car? Calm Excited Aggressive Gets carsick How is this dog at the dog park or in public? Happy/friendly Calm Aloof Nervous/Shy Aggressive Please list anything else you would like us to know that could help us match this dog with the appropriate adopter? I attest that all of the above are true/Please type your signature Date MM DD YYYY Thank you! We will contact you about next steps. If you do not hear from us, please email us at streetdogpals@gmail.com
