Name: Street Address: City: State and Zip Code: Phone Number: Email Address: Why wanting to surrender: Contacted Other Rescue Groups: Yes No If Yes, who: Information About the Dog: What Sex is the Dog (Male or Female): Name of Dog: Age of Dog: Color of Dog: Ears: Natural Cropped Tail: Docked Natural Is dog altered: (Spayed/Neutered) Yes No Is the Dog Up to Date on Vaccines: Yes No Need On Heartworm Preventative: Yes No Is the Dog Crate Trained: Yes No Unknown Is the Dog House Trained: Yes No Unknown Dog Good with Other Dogs: Yes No Unknown Good With Children: Yes No Unknown Dog Good With Cats: Yes No Unknown Is the Dog Toy Aggressive: Yes No Unknown Is the Dog Food Aggressive: Yes No Unknown Dog Bitten Another Animal: Yes No Explain any aggressive issues: Dog Bitten or Attempted to Bite a Person: Yes No If Yes, explain: