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SNBTR Owner Surrender Questionnaire

SNBTR Owner Surrender Questionnaire

Southern Nevada Boston Terrier Rescue (SNBTR)
501c3, Non-Profit Organization

*ALL PERSONAL INFORMATION IS CONFIDENTIAL*

We are sorry about the circumstances leading to the need to surrender your Boston, but we thank you for putting your Boston's needs first and considering their best interests and well-being.

We look forward to working with you and would appreciate your answers to the following questions. Your answers will assist us in placing the dog into a foster home that is best suited for the dogs needs and will help make the transition into our rescue as easy as possible.

Once we have reviewed your submission, a volunteer will contact you to discuss the next step in the process of surrendering a dog. We appreciate your patience as we are all volunteers.

Thank you for your cooperation.

If you have any questions, please contact us at info@SNBTR.com. Thank you!

Name of Surrendering Owner: (confidential) * First Last
Email *
Phone * - ### - ### ####
Location: Major Cross Streets *
How many Bostons are being surrendered? *Please complete a separate form for each dog.* *
Name, Age, Gender of the Boston being surrendered: *
Why is the dog being surrendered? *
Where did you get this Boston from? (Breeder, Rescue, Pet Store, Friend, Craigslist or other Ad, etc.) *
When does the dog have to be out of your care by? *
Is the dog house trained? *
Yes No
Is the dog crate trained? *
Yes No
Is the dog friendly to cats? *
Yes No Never been around cats
Is the dog friendly to dogs? *
Yes No Never been around dogs Other
Is the dog friendly to kids? *
Yes No Never been around kids Other
Has the dog ever bitten anyone causing injury? *
Yes No
Please tell us about the dog's personality, likes, dislikes, quirky behaviors, etc: *
Explain any previous or current medical issues: *
Is the dog fixed-spayed/neutered? *
Yes No Other
Can you provide vet records? *
Yes No
Can you provide proof of vaccines? *
Yes No
Is the dog microchipped? *
Yes No Unknown
What food is the dog currently eating? *
Describe what kind of home do you think would be best for the dog: *
Please tell us anything about the dog that you feel is important: *
Are you attempting to re-home the dog on your own? *
Yes No
Do you agree to sign a release of ownership agreement upon transfer of the dog? *
Yes No
Please attach a picture of the Boston. You can also email it to info@snbtr.com.

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Date / MM / DD YYYY