WISE Animal Rescue Surrender Application Owner's Information First Name* Last Name* Date of Birth* Street Address* City* State* Zip Code* Email* Home Phone Cell Phone* Work Phone Are you the owner of the animal?* Yes No If no, where is the owner? Pet's Information Pet's Name* Nickname* Breed* Spayed/Neutered* Yes No Age* Date of Birth Pet's History How long has this pet lived with you?* Where did you obtain the pet?* If from a breeder or rescue group, did you contact them before surrendering your pet here?* Yes No Why are you surrendering your pet? No time Owner Medical Issues Pet Medical Issues Behavioral Problems Moving Other Please explain why you are surrending your pet.* Who is your current veterinarian?* Is your pet current on his/her rabies vaccination?* Yes No Is your pet current on his/her distemper vaccination?* Yes No Date of last rabies vaccination* Date of last distemper vaccination* Does your pet have any current health issues?* Yes No Please explain the current health issues. Does your pet have any past health issues?* Yes No Pet's Behavior When left alone, does your pet:* Destroy household items Urinate Defecate Bark Cry Nothing Is your pet crate-trained?* Yes No Is your pet house trained?* Yes No How does your pet greet strangers?* How does your pet greet other animals outside of the home or in general?* Has your pet had any experience with children?* Yes No Would you recommend your pet to be placed in a home with children?* Yes No Has your pet ever bitten or nipped you or anyone else?* Yes No Did the bite(s) break skin?* Yes No Was there stitches?* Yes No Please explain the details of the bite.* Has your pet lived with other animals?* Yes No Species Ages Sizes of other animals. Has your pet ever fought with another animal?* Yes No Please explain. Are there areas on your dog's body that he/she does NOT like to be touched? Ears Mouth Head Neck Tail Rear-end Paw/Nails Can touch anywhere Other If touched in the above place(s), how does your pet respond? Moves away Shows teeth Growls Snaps Bites No reaction Other Please tell us about your pet's "bad behavior" or fears.* Is there anything specific about your pet that you would like to share to make the transition easier?* What is your pet's potty schedule?* What is your pet's meal schedule?* Where does your pet sleep? Describe sleeping habits.* Describe the ideal home for your pet.* Have you consulted with a professional trainer about your pet?* Yes No Other Do you understand that once you surrender your pet, he/she becomes the propter of Wise Animal Rescue?* Yes No Do you understand you will not get your pet back after he/she is surrendered?* Yes No Do you understand that you will be expected to make a monetary donation to help care for your pet once surrendered?* Yes No Please be aware that once a pet is surrendered, it becomes the property of Wise Animal Rescue.Certain unforeseen circumstances may warrant euthanasia.By hitting SUBMIT APPLICATION, I certify that the above information is true and accurate to the best of my knowledge and I understand that my completion of this form in no way obligates WISE to accept my dog into the rescue. By submitting this application, I authorize WISE to contact my veterinarian and contact anyone listed. Comments Submit Application
