Phone: 801-423-1334 ~ Fax: 206-202-1961 ~ E-mail: lostpawsinc@gmail.com ~ Hours: 9-5pm Mon-Fri (when able)

(Please read the Surrender Process here first)

LOST PAWS, Inc.

Part A: DOG RESUME

THIS FORM MAY TAKE APROX. 15 - 20 MINUTES TO COMPLETE

No one knows and loves your dog the way you do. In order to find the most appropriate home for your dog, please provide as much detail as possible. Remember that behavioral and medical issues do not necessarily create problems, but failing to disclose them certainly does!

General Information:

Dog’s Name:
Dog’s Age (or approximate age):
Dog’s Birthdate (if known):
Breed:
Color:
Dog’s Sex:	Male Female
Is your dog spayed/neutered?	No Yes Unsure

History:

Why are you surrendering your dog?
If surrender reason is behavioral, please explain:
How long have you owned your dog?
Including yours, how many homes has this dog had?

Medical History:

Who is your veterinary?
Is your dog current on vaccinations? No Yes

Personality:

How would you describe your dog most of the time? (check all that apply)

Friendly to family	Very active	Clown	Couch potato
Friendly to visitors	Playful	Aloof	Withdrawn
Shy to family	Affectionate	Independent	Shy to visitors
Quiet	Lap dog	Fearful	Fearless
Solitary

Habits:

Does your dog:

Bark excessively	Urinate/spray on items	Kill rodents or birds
Chew plants	Dig in plants	Get on furniture
Sleep on the bed	Climb fences	Food protection/aggression
Toy protection/aggression

Has your dog ever shown any of the following behaviors?

Growling	Baring teeth	Lunging	Nipping
Snapping	Aggression	None

Has your dog ever bitten someone and broken the skin? No Yes
If Yes, explain:

Play Style

How does your dog like to play? (check all that apply)

Plays gently, does not usually use teeth or claws	Likes to play rough, may bite or scratch
Not interested in play	Likes to chase & play with variety of toys
Will fetch items like balls and sticks	Likes to learn tricks for treats
Likes to play in or around water	Likes to play with other dogs

Lifestyle & Home Life

What areas of your home did your dog have access to? (check all that apply)

Indoors only	Outdoors only	Indoors at night	Garage/basement
In barn or shed	Indoors with access to outside	Other

Where did your dog spend most of his or her time? (check all that apply)

Bedroom	Kitchen	Living room	Garage or basement
Outdoors only	Barn or shed	Where people are	Other

Would you recommend that your dog be placed in a home with other animals?

Any animals

Other dogs

Cats

No other animals

Would you recommend that your dog be placed in a home with children?

Any age

Over 5yrs

Over 10yrs

Teenagers

No children

Have the experiences with the dog and child(ren) always been positive? No Yes
If No, please explain:

Is your dog more comfortable with:
Women Men Kids Teenagers Seniors All people

Dietary Habits

What is the dog’s favorite brand of food?

House Training or Professional Training

Is you dog house trained?
No Yes
Has occasional accidents Has frequent accidents
Under what circumstances might your dog have an accident?

Is your dog trained to:
Potty Pads Doggy door Crate trained Outside

For how many hours a day is your dog comfortable being left alone?

Where did your dog spend the night?
Inside, unconfined Inside, confined to room or crate In garage or basement Outside
Other:

How would you describe the ideal home for your dog?

Please tell us some things you truly love about your dog:

Are there any quirks or habits you are not fond of in your dog?

Has your dog been through any obedience training? No Yes
If Yes, what commands does your dog know?

Sit	Stay	Down	Play dead
Speak	Shake	Roll over	Heel
Other:

Additional comments about your canine (if any):

Part B: DOG SURRENDERING FORM

YOU MUST BRING A COMPLETE COPY OF YOUR PET'S MEDICAL RECORDS WITH ANIMAL DROP-OFF

We require a complete copy of current medical records stating that the animal is current on all vaccinations.

Surrendering fees help to offset the costs of veterinary care for rescued animals. The surrendering party agrees to pay to LOST PAWS, Inc. the surrendering fee of $45.00 (Forty-Five Dollars) for each dog/puppy.

If you are placing your animal up for adoption because of a behavior or medical problem,
YOU MUST DISCLOSE THIS PROBLEM TO US.

Personal Information

Your Name:
Address:	City:	State:	Zipcode:
E-mail:
Home Phone:
Work Phone:

How did you hear about LOST PAWS, Inc.?

Agreement

I represent and warrant that I am the lawful owner/agent of the Animal(s) and that I have disclosed to LOST PAWS, Inc. all material information regarding the medical and behavioral history of the Animal(s). I understand that by releasing the Animal(s) to LOST PAWS, Inc. I relinquish all ownership or other interest in the Animal(s). I hereby release and forever discharge LOST PAWS, Inc. from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the Animal(s). And I agree to indemnify and hold harmless LOST PAWS, Inc. from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties. I further acknowledge that I am releasing the Animal(s) completely voluntarily and that no representations or promises of any kind have been made to me by LOST PAWS, Inc. or any of its agents.

I hear by also agree to the undersigned fee for above said dog/puppy is for medical attention and proper care of this animal.

Surrendering Party Initials: *

Payment Information

Surrendering Donation Amount:	$
Would you like to make a donation to the LOST PAWS, Inc. adoption program?	$

Total Donation Amount:	$

Payment Note (if any):

YOU MUST BRING A COMPLETE COPY OF YOUR PET'S MEDICAL RECORDS AS WELL AS YOUR TOTAL DONATION AMOUNT WITH ANIMAL DROP-OFF

-- END OF DOG RÉSUMÉ AND SURRENDER FORM --

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- Adopt a Pet - Surrender a Dog - Surrender a Cat

LOST PAWS, Inc.

Part A: DOG RESUME

Part B: DOG SURRENDERING FORM

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