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LDR Surrender Request Form
Owner Information
First name
*
Last name
*
Phone
*
Email
*
Multi-line address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
Dog's Information
Name of dog
*
Age of dog
*
Breed of dog
*
Sex of dog
*
Male
Female
Approximate Weight of dog
*
Are there any other unique identifiers for your dog not mentioned (appearance, etc)?
*
Is the dog spayed or neutered?
*
Yes
No
Is the dog microchipped?
*
Yes
No
Unsure
If the dog is microchipped, please provide important details for tracking and care. (Microchip company, chip#, name and information of registered owner, etc.)
How long has the current owner owned the dog?
*
Where was the dog acquired? (Breeder, stray, shelter, etc.)
*
Reason for Surrender
Why is the dog being surrendered? This helps understand the underlying issues and potential solutions.
*
If the reason is behavioral, what have they tried to address the issue? This can indicate if the behavior is manageable and what resources might be helpful.
*
If the reason is a move, have they explored pet-friendly housing options? Some rescues may offer resources to help keep pets with their owners.
*
Health & Medical History
Has the dog been seen by a veterinarian? If yes, when was the last approximate visit?
*
Is the dog up-to-date on vaccinations? If not, which ones are due?
*
Does the dog require any medication? If yes, please provide medication, dosage, and reason the dog is on it.
*
Has the dog ever been diagnosed or treated for any medical problems or previous injuries?
*
Lifestyle & Habits
Where does the dog spend most of its time (indoor, outdoor, both)?
*
Where does the dog sleep at night?
*
How much exercise does the dog get and what type?
*
What is the dog's favorite kind of play?
*
How does the dog interact with toys?
*
What brand of food does the dog eat and how often?
*
Does the dog have any allergies or sensitivities (food allergies, skin allergies, etc.)?
*
Does the dog allow for grooming tasks like nail clipping and brushing?
*
Additional Information
What are the dog's positive qualities and what do you love most about the dog?
*
What else should be known about the dog that would help with their care and finding them a good home?
*
Please provide recent photos of the dog. Email the photos to janetsailortobin@comcast.net after form submission.
Submit
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