"A Better Life Rescue, Inc."
501(c)(3) non-profit corporation

First and Last Name:
Email Address:
Street Address:
City, State and Zip Code:
Home Phone Number:
Cell Phone Number:
Dog's Name:
Dog's Age:
Dog's date of birth:
Male or Female?
Current Weight:
Please click all that applies. Had pet since puppy
Adopted pet as an adult
Someone gave me my pet
Adopted pet from another Rescue
Purchased from a Breeder
Purchased from a Pet Store
Is your pet microchipped? Yes
Check boxes that apply: Ears are up
Ears are down
Short tail
Long tail
Short hair
Medium hair
Long hair
Will need normal grooming
Just had pet groomed
Heavily matted & dirty
Reason for surrender:
How long have you owned your pet?
What is the name of the dog food you are currently feeding your pet?
Is your pet on monthly Heartworm Treatment? If so, what brand?
Date of last dental cleaning?
Is your dog housebroken? Yes, totally
Pee Wee Paper Trained
Litter Box Trained
Lifts Leg and Marks
Pees indoors
No, not trained at all
Is your dog crate trained? Yes, loves it.
No, hates it.
Never used a crate.
Where does your pet sleep at night? In bed with me/us.
In bed with the kids.
In his crate.
In his own bed.
In our room on floor.
In a gated off area in house.
Anywhere he wants.
In the backyard.
Out on the lanai/screened porch.
Is your dog leash trained? Yes
Goes in backyard only
Never leaves the house
State any health issues here:
If there are health issues, please state the care currently being given.
Date of last Vet visit.
Veterinarian's name, address and phone number.
May we contact your vet? Yes
Contact me first
Is your dog current on vaccinations? Yes
Not sure
Spayed or Neutered? (fixed) Yes
Is your pet child friendly? Yes
Does not like small children
Does not like ALL children
Is your pet friendly with other dogs? Yes, with all dogs.
Yes, with small dogs only.
Does not like other dogs.
Is your pet friendly with cats? Yes
Has your pet ever done any of the following: Growled
Shown aggression
Food aggressive
Toy aggressive
Aggressive towards Dogs
Aggressive towards Cats
Aggressive towards Kids
Are you willing to make a donation to A Better Life Pet Rescue? BLPR is dependent on donations to provide the necessary health care to our rescues. Yes
Financially unable to.
May we refer your request to another reputable group if we are unable to help you? Yes
Can you email us a photo of your pet? If so please send it to abetterlifepetrescue@yahoo.com or text it to 305-978-0059. Yes
Will email you a photos
Will text you a photo
Any additional comments you wish to make?
Please complete this form if you are considering the surrender of your dog. We realize this form is a bit lengthy but please fill it out as completely as you can. It will help us better suit the needs of your pet.

Surrendering your dog is an irrevocable decision; once surrendered, you release your rights as a pet owner. A Better Life Pet Rescue does not return or re-adopt dogs to the surrendering owner. However we also know that surrendering your pet can be an emotional experience and we will do everything we can to help facilitate a comfortable transition for both you and your pet.

A representative from A Better Life Pet Rescue will be in contact with you as soon as possible.