Bull Terrier Rescue Inc. Surrender Form

Bull Terrier Rescue Inc. Surrender Form

* Denotes a Required Field

Your Name*

Street Address*



Zip Code*

Phone Number*

Best time to call:

Your Email*

Your relationship to the dog?*

Identifying Information

Dog's name?*


Is the dog neutered/spayed?*:


Weight? (estimate if unknown)*

Registered name?

Breeder's name?

Breeder's address?

Dam's name?

Sire's name?

Dog's call registered name?

Registration number?

Are registration papers available?

Describe the dog's ears

Describe markings or scars?

Type of identification*

Medical Information

Does your dog have any allergies, medical conditions, and/or required medications?*

If so, please describe

Describe the overrall mental and physical condition of the dog*

Is the dog current on all vaccinations and heartworm treatment?*

Veterinarian name

Veterinarian hospital

Veterinarian hospital address

Veterinarian phone number

Is the dog deformed in any way?*

If so, please describe

Is the dog deaf?*

Is the dog blind?*

Describe any hearing or vision problems the dog may have

What brand of dog food is currently being fed to the dog?

How much per day?

Describe the condition of the dog's teeth*

Any other medical related comments?

Temperament Information

Describe the dog's temperament?*

Has the dog bitten anyone, or attempted to bite anyone?*

If so, describe

Is the dog:

Good with other dogs?*

Good with cats?*

Good with small animals?*

Good with men?*

Good with women?*

Good with young children?*

Good with older children?*

Protective of food/toys?*

If so, describe

A digger?*

An excessive barker?*

A climber?*

A chewer?*

Has the dog fought with other dogs?*

If so, describe

Has the dog ever injured or killed another animal?*

If so, describe

Training Information

When on a leash, the dog:*

Is the dog obedience trained?*

Is the dog housebroken?*

If so, how does the dog communicate this?

Please check the type of housing the dog has lived in*:
IndoorsBasementGarageFenced Yard
Kennel RunOutside Tied UpOutside Loose
Is the dog destructive of property?*

If so, give details?

Is the dog crate trained?*

If so, how many hours has the dog been crated per day?

Does the dog have a favorite toy, game, or food? If so, what is it?

How does the dog react to riding in the car?

Where does the dog spend its days?

Where does the dog spend its nights?

Why are you surrendering the dog?

Describe your ideal home for the dog?

Any additional information you're like to share?