Surrender Application What is the best time of day to contact you? *
How did you hear about TSBR? *
Choose one:
Advertisement: Print
Advertisement: Radio
Advertisement: TV
Craig's List
Event: Adoption
Event: Other
TSBR Web Site
Other
Repeat Adoption
Google Search
Word of Mouth
Web Site: Adopt-a-Pet.com
Web Site: AtlantaPets.org
Web Site: Dog.com
Web Site: DogTime.com
Web Site: Facebook
Web Site: Facebook Save a Cat App
Web Site: Facebook Save a Dog App
Web Site: LiveDeal.com
Web Site: Parade.com
Web Site: Pedigree.com
Web Site: PetBond.com
Web Site: Petfinder.com
Web Site: PetHarbor.com
Web Site: Pets911.com
Web Site: Petsmart.com
Web Site: PetStyle.com
Web Site: Post-Intelligencer
Web Site: RottNet.net
Web Site: TheFoundBin.com
Our ability to help is based on foster home availability. Are you willing to foster your dog through adoption? *
Choose one:
Yes
No
Undecided
Please explain *
Information About Your Dog
Dogs Name *
Breed of dog you want to surrender (based on the AKC Sporting Group Breeds) *
Choose one:
American Water Spaniel
Boykin Spaniel
Brittany
Chesapeake Bay Retriever
Clumber Spaniel
Cocker Spaniel
Curly-Coated Retriever
English Cocker Spaniel
English Setter
English Springer Spaniel
Field Spaniel
Flat-Coated Retriever
German Shorthaired Pointer
German Wirehaired Pointer
Golden Retriever
Gordon Setter
Irish Red and White Setter
Irish Setter
Irish Water Spaniel
Labrador Retriever
Nova Scotia Duck Tolling Retriever
Pointer
Spinone Italiano
Sussex Spaniel
Vizsla
Weimaraner
Welsh Springer Spanie
Wirehaird Pointing Griffon
Age of Dog *
Color or Special Markings *
Sex *
Choose one:
Male
Female
Either
Weight *
Please provide the name and phone number of the veterinarian that has most recently seen this dog. *
Phone Number *
Does your dog have any medical conditions? *
Choose one:
Yes
No
Undecided
If you dog has a medical condition, please explain. *
Spayed/Neutered *
Choose one:
Yes
No
Is the dog current on vaccinations? *
Choose one:
Yes
No
Undecided
Has the dog tested negative for Heartworms in the last 6 months? *
Choose one:
Yes
No
Undecided
Is the dog currently on monthly heartworm prevention? *
Choose one:
Yes
No
Undecided
How long have you had the dog? *
Is the dog a stray? *
Choose one:
Yes
No
If the dog is a stray, what measures have you taken to try and locate the owners? *
Do you have other dogs in your home? *
Choose one:
Yes
No
Where did you get this dog? *
Choose one:
Breeder
Craig's List
Friend
Newspaper
Other
Pet Store
Rescue
Stray
Why do you wish to rehome your dog? *
The information below will help us determine a suitable placement for your dog.
Has your dog every bitten or broken skin on a person? *
Choose one:
Yes
No
If your dog has bitten or broken skin on a person, please explain in detail. *
Has your dog attacked another dog or animal? *
Choose one:
Yes
No
Undecided
If your dog has attacked another dog or animal, please explain. *
Does your dog have anxiety or fear (please check all that apply)?
How does your dog feel about the following?
Swimming *
Choose one:
Doesn't Like
LOVES
Likes
Somewhat
Tolerates
Other Dogs *
Choose one:
Doesn't Like
LOVES
Likes
Somewhat
Tolerates
Cats *
Choose one:
Doesn't Like
LOVES
Likes
Somewhat
Tolerates
Children *
Choose one:
Doesn't Like
LOVES
Likes
Somewhat
Tolerates
Riding in the Car *
Choose one:
Doesn't Like
LOVES
Likes
Somewhat
Tolerates
Baths or General Grooming *
Choose one:
Doesn't Like
LOVES
Likes
Somewhat
Tolerates
Strangers *
Choose one:
Doesn't Like
LOVES
Likes
Somewhat
Tolerates
Dog Park *
Choose one:
Doesn't Like
LOVES
Likes
Somewhat
Tolerates
Please provide any other likes/dislikes your dog may have. *
Is your dog...
Does your dog...
Does your dog know...(on command)
Can you leave your dog unattended in the house for long periods of time without damage or destructive behavior? *
Choose one:
Yes
No
Undecided
Where do you keep the dog when you are away? (work, errands, school, etc.?) *
Choose one:
Dog door - access to home and yard
Inside - confined to a crate
Inside - confined to a room
Inside - free roam of the house
Outside
I have not owned or been responsible for a dog in the past 10 years
Is your dog *
Choose one:
Inside (the dogs lives in the house, going outside for play and relief)
Outside (the dog lives outside, and is not permitted inside the house)
Will your dog jump a fence? *
Choose one:
Yes
No
Undecided
How tall is your current fence? *
Does your dog dig, climb, or otherwise escape enclosed areas? *
Choose one:
Yes
No
Undecided
Please describe a typical 24-hour day in your dogs life. *
Additional Comments *
By submitting an application and checking this box, I grant TSBR and its volunteer's permission to contact me by phone, email, text message, and mail to the contact information I am submitting. In addition to communication-related to your application status, you may also receive occasional newsletters, event, and fundraising notifications from TSBR. We will not sell or distribute your email address to any third party at any time. You may unsubscribe at any time.
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