Email Address

Name

First Name

Last Name

Phone Number

(###)

###

####

Dog's Name

Dog's Age/Date of Birth (if known)

Dog's Breed

Dog's Weight

Dog's Color

Dog's Sex

Dog's Tail

Dog's Microchip Number (if known)

Vet's Name and Phone Number

Last Vaccination

Last Rabies Shot

Last Grooming/Bath

Where was the dog acquired?

Name of above (breeder, shelter, rescue, pet store, etc?)

Where is the dog now? (City/State)

Reason for Giving Up?

Temperament? Specifically - how is dog with: women? men? children under 10? other dogs? cats? birds?

Has this dog ever bitten/nipped? If so, what were the circumstances?

Is the dog crate trained?

Is the dog housebroken? (to a dog door/other?)

Where has the dog been kept during the day and night (indoors/outdoors)?

How does the dog walk on a leash (trained to heel? pulls? etc)?

Level of obedience? (Include known commands?)

Any current medical conditions/required medications? (Please be specific)

Name of Legal Owner

First Name

Last Name

Contact Info for SDSR (if different from relinquisher) Name, Phone, Address, Email

Do you have a current photo of the dog?

Additional Information

There is no fee associated with relinquishing your dog. Any donation to SDSR to offset costs
(medical needs, foster care, food, grooming, etc.) would be greatly appreciated.

There is no fee associated with relinquishing your dog. Any donation to SDSR to offset costs(medical needs, foster care, food, grooming, etc.) would be greatly appreciated.