Bull Terrier Rescue Inc. Surrender Form

Bull Terrier Rescue Inc. Surrender Form

Please complete this application by computer or laptop as submissions via phones and tablets are not being received. Thank you!

* 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?