Today's Date
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Name
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First Name
Last Name
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
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Phone
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(###)
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Dog's Name
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Did you adopt from TTCHS?
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Where did you get your dog?
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How long have you owned your dog?
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What breed is your dog?
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How much does your dog weigh?
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What age is your dog?
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What is your dog's gender?
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Why are you surrendering?
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Please briefly explain why you are looking to surrender your dog.
Traits & Habits
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Are there any wonderful, special traits or habits that you would like his/her new family to know about?
Does your dog have accidents in the house?
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Is your dog crate trained?
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Household Item(s) Damage
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When your dog is alone and damages household items, please check all behaviors that apply.
Play Style
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Please describe your dog's play style/energy level.
Does your dog get along with other dogs?
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Does your dog get along with cats?
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Does your dog like children?
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Touch Sensitivity
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Are there areas on the dog’s body your dog does NOT like to be touched? Please check all that apply.
Touch Response
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If touched in any of the above places how does your dog respond?
Has your dog ever bitten a person?
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Car Behavior
How does your dog behave in the car? Please check all that apply.
Behavior when Eating
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How does your dog react when you or another family member pet him/her or touch the bowl or food while he/she is eating? Please check all that apply.
Behavior with Toy in Mouth
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Behavior when on Furniture
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How does your dog react when you or another family member pushes or pulls him/her off of furniture?
Training
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Has your dog completed any training? If so, please describe.
Commands
What commands does your dog understand?
What are the dog's favorite kinds of toys?
Behavior while Sleeping
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How does your dog react when you or another family member pets him/her or moves him/her while sleeping?
Has your dog been spayed or neutered?
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Has your dog ever had surgery?
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If your dog has had surgery, please explain:
Please include the date, type of surgery, and the veterinary who performed the surgery.
Has your dog been tested for Heartworm?
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Vet Info
Please provide your veterinarian's name and phone number (TTCHS will require records prior to placement).
Medication
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Is your dog on any medication? If so, please provide the name, dosage, and how long they have been taking each.
Does your dog have any known allergies?
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If so, please list them below.
Additional Information
Is there anything you want a new family to know about your dog’s interaction with men, women, children, other dogs, cats, other animals or people?
Surrender Alternatives
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Prior to animal surrender, do you agree to attend a mandatory meeting discussing surrender alternatives with a TTCHS representative (such as training techniques or behavior assistance)?
