Surrender Form

www.ABetterLifePetRescue.com

"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:
Breed:
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 No Unknown
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 Sometimes 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 No 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 No Contact me first
Is your dog current on vaccinations?	Yes No Partially Not sure
Spayed or Neutered? (fixed)	Yes No Unknown
Is your pet child friendly?	Yes Does not like small children Does not like ALL children Unknown
Is your pet friendly with other dogs?	Yes, with all dogs. Yes, with small dogs only. Does not like other dogs. Unknown.
Is your pet friendly with cats?	Yes No Unknown
Has your pet ever done any of the following:	Growled Snarled Bitten 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 No Financially unable to.
May we refer your request to another reputable group if we are unable to help you?	Yes No
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 No 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.