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Dog surrender form

Please remember we are an entirely volunteer-based organization that receives dozens of intake requests daily. Please be patient, and we will respond as quickly as we are able.

Your full name*

Email*

Phone*

Pet's name*

Breed*

Age*

Weight*

GenderMaleFemale

Is your animal spayed and neutered?YesNo

Can you provide vet records?YesNo

Has a dental cleaning been done?YesNo

Is your dog's rabies vaccination current with proof?YesNo

Is your dog's DHPPV vaccine current with proof?YesNo

Is your dog's bordetella vaccine current with proof?YesNo

Has your animal bitten anyone or have any history of aggression? Please describe the situation if applicable.*

How much can you donate to FLPS toward this dog's care?*

Your dog is (check all that apply):Good with small dogsGood with large dogsNot good with dogsGood with catsNot good with catsGood with kidsNot good with kids

Is your animal on any medications?YesNo

If your pet is on any medications, please explain:*

Is your dog housetrained?YesNo

Are there any behavioral issues?YesNo

If there are any behavioral issues, please explain:*

What is the reason for surrendering your animal?*

Preferred surrender date:*

Digital Signature (retype your full name)*

Thank you! Your submission has been received!

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Forever Loved Pet Sanctuary
P.O. Box 12142
Scottsdale, AZ 85267

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