Bull Terrier Rescue Inc. Surrender Form Bull Terrier Rescue Inc. Surrender Form * Denotes a Required Field Your Name* Street Address* City* State* ---ALAKAZARBCCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYNON-US Zip Code* Phone Number* Best time to call: ---MorningAfternoonEvening Your Email* Your relationship to the dog?* Identifying Information Dog's name?* Color?* Is the dog neutered/spayed?*: ---YesNoUnknown Birthdate/Age? 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? ---YesNo Describe the dog's ears ---ErectSoft Describe markings or scars? Type of identification* ---TattooMicrochipNone Medical Information Does your dog have any allergies, medical conditions, and/or required medications?* ---YesNoUnknown If so, please describe Describe the overrall mental and physical condition of the dog* Is the dog current on all vaccinations and heartworm treatment?* ---YesNoUnknown Veterinarian name Veterinarian hospital Veterinarian hospital address Veterinarian phone number Is the dog deformed in any way?* ---YesNo If so, please describe Is the dog deaf?* ---YesNoUnknown Is the dog blind?* ---YesNo 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?* ---YesNoUnknown If so, describe Is the dog: Good with other dogs?* ---YesNoUnknown Good with cats?* ---YesNoUnknown Good with small animals?* ---YesNoUnknown Good with men?* ---YesNoUnknown Good with women?* ---YesNoUnknown Good with young children?* ---YesNoUnknown Good with older children?* ---YesNoUnknown Protective of food/toys?* ---YesNoUnknown If so, describe A digger?* ---YesNoUnknown An excessive barker?* ---YesNoUnknown A climber?* ---YesNoUnknown A chewer?* ---YesNoUnknown Has the dog fought with other dogs?* ---YesNoUnknown If so, describe Has the dog ever injured or killed another animal?* ---YesNoUnknown If so, describe Training Information When on a leash, the dog:* ---PullsHeelsWon't Walk Is the dog obedience trained?* ---YesNoUnknown Is the dog housebroken?* ---YesNoUnknown 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?* ---YesNoUnknown If so, give details? Is the dog crate trained?* ---YesNoUnknown If so, how many hours has the dog been crated per day? ---<2 hours<4 hours<6 hours<8 hours>8 hours 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?