Lab Rescue of Greater Richmond
Application for Surrender
Owner's Information
Owner's Name
First Name
Last Name
Contact E-mail:
*
Cell Number:
*
Co-Owner's Name
First Name
Last Name
Contact E-mail:
Cell Number:
Address where the dog is located
*
Street Address
City
State / Province
Postal / Zip Code
Are you the legal owner of the dog being surrendered?
*
Yes, I am the legal owner
No, I am completeing the form for the legal owner
If not the legal owner,who is the legal owner of the dog.
Legal owner;s Name and Phone Number
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
*
Upload a File
Choose a photo that claerly shows the dogs face/head / ears
Cancel
of
Standing side body/ tail photo
*
Upload a File
Choose a photo that clearly shows the dog standing.
Cancel
of
Dog's Name:
*
Is the dog a pure bred Lab?
*
Please Select
Yes
No
Unsure
If known, what is the breed mix of the dog?
Birthday, If known
-
Month
-
Day
Year
Date
Age:
*
Weight:
*
Color:
*
Please Select
Black
Yellow
Chocolate
Silver
Fox Red
Sex:
*
Please Select
Male
Female
Is your female spayed?
Yes
No
If no, when was the start of her last heat cycle?
Is your male neutered?
Yes
No
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?
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Inside, Free rein
Inside Crated
Baby Gated inside
Outside
Kennel/Pen outside
Doggie Day Care
Comments:
*
Where does your dog stay at night?
*
Inside, Free rein
Inside/ Crated
Baby Gated inside
Outside
Kennel/Pen outside
Comments:
*
Is the dog house trained?
*
Yes
No
Is your yard fenced?
*
Yes
No
Other
If yes, will the dog jump over the fence.
Yes
No
Comments on height and style of fence.
Are there other pets in the home?
*
Yes
No
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 own
I have used a profesional trainer
The dog has received no training
Professional Trainer's Company/Name
Type of training equiptment used
*
Flat collar
Harness
Prong collar
E-collar
Gentle leader
Clicker
Spray bottle
Treats
Other
The dog knows/displays the following
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Likes to fetch
Likes to swim
Likes car rides
Jumps on people
Nervous in the car
Barker
Good on leash
Knows Down
Pulls on leash
Knows Sit
Knows Come
Knows Stay
Social with People
High Energy
Low energy
Food Motivated
Prey Drive
Other
Comments on any of the above
*
Dog's Temperament
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Social / Friendly with Strangers (People)
Nervous / Needs time to warm up
Playful/Outgoing
Calm and Relaxed
Easily Distracted
Shy/ Easily Frightened
Other
Comments on any of the above
*
Dog Friendliness
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Dog Friendly
Friendly with small dogs
Aggressive with small dogs
Dog aggressive
Reactive to other dogs
Other
Please explain how your dog greets other dogs.
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Appropriately sniffs ,comes in fast, growls, lunges, barks, happy and comfortable, stiffens
Cat Friendliness
*
Aggressive with cats
Cat Friendly
Unknown
Other
Is your dog good with children
*
Please Select
Yes
No
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?
*
Yes
No
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.
*
Food
Toys
Crate
Bed
Humans
Other Dogs
Other
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?
*
Rabies
Distemper/Parvo/lepto
Bordetella
Not current on vaccines
Is the dog currently on Heartworm preventative?
*
Yes
No
When was preventative last given?
Date of last Heartworm test:
Flea preventative?
*
Yes
No
Does your dog take any medication? If so please list here
*
Stairs, wood floors,etc
Is the dog Microchipped?
*
Please Select
Yes
No
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.
*
Yes
No
Reason for giving up the dog?
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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 possible
Remove within a few weeks
Can 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?
YES
NO
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
Submit
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