Application for Surrender

Lab Rescue of Greater Richmond
P.O. Box 1574, Midlothian, VA 23113-1574

info@labrescue-richmond.com
Application for Surrender
Applicant's Information
Applicant's First Name:*
Applicant's Last Name:*
E-mail:*
Cell Number:*
Co-applicant / First Name:
Co- applicant / Last Name:
E-mail:
Cell Number:
Address*

Street Address

CityState / Province

Postal / Zip Code
Are you the legal owner of the dog being surrendered?*
If not the legal owner, please explan below.
Dog's Information
Photos of face & body

Take photo at dog's level.
Face/head, ears photo *
Choose a photo that claerly shows the dogs face/head / ears
Standing side body/ tail photo*
Choose a photo that clearly shows the dog standing.
Dog's Name:*
Is the dog a pure bred Lab?*
If known, what is the breed mix of the dog?
Birthday, If known

MonthDayYear
Date
Age:*
Weight:*
Color:*
Sex:*
Is your female spayed?
If no, when was the start of her last heat cycle?
Is your male neutered?
How long have you owned the dog?*
Where did you get the dog?*
Dog's Home Life
How many hours is the dog home alone on a typical work day?*
Where does your dog stay when you are away from the home?*

Inside, Free reinInside CratedBaby Gated insideOutsideKennel/Pen outside
Comments:
Where does your dog stay at night?*

Inside, Free reinInside/ CratedBaby Gated insideOutsideKennel/Pen outside
Comments:
Is the dog house trained?*

YesNo
Is your yard fenced?*

YesNoOther
If yes, will the dog jump over the fence.

YesNo
Comments on height and style of fence.
Are there other pets in the home?*
Please tell us about the other pets in the home and how this dog behaves around those pets.
What is the current exercise routine?
What is the brand of dogfood used and feeding schedule?*
Your Dog's Personality and Training
Training*

I have trained on my ownI have used a profesional trainerThe dog has received no training
Professional Trainer's Company/Name
Type of training equiptment used*

Flat collarHarnessProng collarE-collarGentle leaderClickerSpray bottleTreatsOther
The dog knows/displays the following*

Likes to fetchLikes to swimLikes car ridesJumps on peopleNervous in the carBarkerGood on leashKnows DownPulls on leashKnows SitKnows ComeKnows StaySocial with PeopleHigh EnergyLow energyFood MotivatedPrey DriveOther
Comments on any of the above*
Dog's Temperament*

Social / Friendly with Strangers (People)Nervous / Needs time to warm upPlayful/OutgoingCalm and RelaxedEasily DistractedShy/ Easily FrightenedOther
Comments on any of the above*
Dog Friendliness*

Dog FriendlyFriendly with small dogsAggressive with small dogsDog aggressiveReactive to other dogsOther
Please explain how your dog greets other dogs. *
Appropriately sniffs ,comes in fast, growls, lunges, barks, happy and comfortable, stiffens
Cat Friendliness*

Aggressive with catsCat FriendlyUnknownOther
Is your dog good with children?*
Yes, No , Unknown
Ages of children the dog has been exposed to
If children are in the home, do the children and dog interact together? Please explain how your dog reacts and interacts with children ( Dogs Body Language) If not good with children, please explain behavior with kids in detail.
Has the dog bitten a child or adult?*

YesNo
If Yes, Please Explain:
Does your dog display any resource guarding with the following. Resource guarding refers to a dog displaying behavior (growling, snapping, etc.) intended to convince other dogs or humans to stay away from a particular treasure or “resource.” The resource can be food, treats, toys, a place (a bed or favorite chair), or occasionally a person.*

FoodToysCrateBedHumansOther DogsOther
If Yes, Please Explain:
Any destructive behaviors?*
Dog's Health Information
Does your dog have any mobility concerns? If Yes, please explain.*
Stairs, wood floors,etc
Is the dog current on vaccines?*

RabiesDistemper/Parvo/leptoBordetellaNot current on vaccines
Is the dog currently on Heartworm preventative?*

YesNo
When was preventative last given?
Date of last Heartworm test:
Flea preventative?*

YesNo
Does your dog take any medication? If so please list here*
Stairs, wood floors,etc
Is the dog Microchipped?*
If Microchipped, where is the chip registered and what is the Microchip Number?
General Health Comments*
Veterinary Information
Veterinarian Practice :*
Veterinarian Practice Phone Number:*
Veterinarian Address:*
If your dog is not up to date on Vaccines and/or Heartworm Test, are you able to get the dog up to date before surrendering?

Yes, I can get my dog up to date prior to surrendering.No, I am unable to financial afford veterinary care for my dog.
* You will need to give your veterinarian permission to speak with a LRGR volunteer.
I have spoken to my veterinarian and have given them permission to speak with Lab Rescue.*

YesNo
Reason for giving up the dog?*
Does the dog need to be removed immediately or are you able to foster the dog while we find a forever home?*

Remove as soon as possibleRemove within a few weeksCan stay until forever home is found
If you have additional information to add to this form, please enter it here:
Will you be donating the dog's crate?
By submitting this electronic form, I acknowledge that all the information on this form is true and correct. I understand that any misrepresentation of fact may result in legal action by Lab Rescue.*

I Agree
Should be Empty:

Lab Rescue of Greater Richmond

Application for Surrender

Applicant's Information

Dog's Information

Photos of face & body

Dog's Home Life

Your Dog's Personality and Training

Dog's Health Information

Veterinary Information