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Upper Credit Humane Society
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Canine Surrender Form

Owner Information

Name(Required)
Address(Required)

Dog Information

Gender(Required)
Spayed or Neutered(Required)

Dog information – Preferences and Behaviour

How often is your dog accustomed to eating?(Required)
What kind of food do you feed your dog?(Required)
My dog is used to living in:(Required)
My dog is house trained:(Required)
My dog lives primarily:(Required)
When I am not home, my dog is kept:(Required)

My dog is used to being alone:(Required)
When left alone, my dog is:
My dog knows
Check all that apply
I can hug my dog:(Required)
I can brush my dog:(Required)
I can trim my dog’s nails:(Required)
In the car, my dog is:

My dog reacts in the following manner:

Unfamiliar environments(Required)
With cats(Required)
With other dogs(Required)
With children(Required)
With men(Required)
With women(Required)
When it comes to furniture, my dog is:(Required)
When I try to remove my dog from the furniture, he/she:
At night, my dog sleeps in my bed:(Required)
My dog protects his/her food:(Required)
If yes, my dog will:
My dog protects his/her toys:(Required)
If yes, my dog will:
My dog protects favourite items e.g. rawhide bone(Required)
If yes, my dog will:
Has your dog ever shown any kind of aggression, such as growling, snapping, lunging, biting, etc?(Required)
Has your dog ever bitten a person or another animal?(Required)
If yes, was the incident reported to Animal Control?(Required)

Health/Medical

Has your dog ever been to a veterinarian?(Required)
Has your dog been vaccinated?(Required)
If yes, when?
Has your dog had any medical issues in the past?(Required)
Does your dog currently have any medical issues?(Required)

Other

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