Surrender Questionairre

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Species *

Dog

Cat

Other

Is this pet Microchipped

Yes

No

Sex: Male/Female *

Male

Female

Is this pet up to date on vaccines?

only select yes if you have proof.

Yes

No

Has this pet ever bit a human? *

Yes

No

Is this pet house trained?

Yes

No

Is this pet crate trained?

Yes

No

Socialization with other dogs *

Friendly

Tolerant

Aggressive

Unknown

Socialization with cats *

Friendly

Tolerant

Aggressive

Unknown

Socialization with children *

Friendly

Tolerant

Aggressive

Unknown

Was this pet previously adopted from Wags and Whiskers *

Yes

No

Was this pet adopted from another shelter/rescue? *

Yes

No