BULL TERRIER CLUB OF AMERICA, INC.

                   RESCUE NETWORK

         

Bull Terrier Surrender Form

If you wish to surrender your Bull Terrier to Bull Terrier Rescue, please make sure you fill out this form in it's entirety.

ALL FIELDS ARE REQUIRED! We understand that this is a very long detailed form, but it is imperative that you provide us as much information as you can. It will help further expedite your dog's case.

 

Contact Information

Your Name
Bull Terrier Organization
Address
City, State
Daytime Phone
Evening or Cell Phone
Best time to call (include time zone)
Email Address
Your Relationship to the dog

Identifying Information

Dog's Color Dog's Gender Male   Female
Is the dog neutured or spayed Yes   No   Unknown Dog's Birthdate
Dog's Weight Dog's Call Name
Dog's Registered Name Registration Number
Are the registration papers available? Yes   No   Unknown
Dam of dog Sire of dog
Breeder Name Breeder Phone Number
Describe the dog's mouth Overbite   Underbite   Level/Scissors Bite   Unknown
Describe your dog's ears Erect   Soft
Describe your dog's nose Black   Pink   Spotted
Please describe any other specific markings or scars
Check the type of identification Tattoo   Microchip   None
Please give number and location of registry information

Medical Information

Does your dog have any allergies, medical conditions, and/or required medications? Yes   No
If so, please decribe
Describe the overall mental and physical condition of the dog
Is the dog current on all vaccinations and heartworm treatment? Yes   No
Explain
Veterinarian Name Vet Phone Number
Vet City and state
Is the dog physically deformed in any way? Yes   No
If so, please explain
Is the dog deaf? Yes   No   Unknown Is the dog blind? Yes   No   Unknown
Please describe any hearing or vision problems the dog may have
What brand of dog food is currently being fed to the dog?
Please docuement and explain any allergies the dog may have, including dietary.
Describe the condition of the dog's teeth.
Any other medical related comments?

Temperment Information

Please describe the dog's temperment.
Has the dog bitten anyone, or attempted to bite anyone? Yes   No   Unknown
If so, please describe.
Is the dog good with: Other dogs Yes   No   Unknown
Cats Yes   No   Unknown
Small Animals Yes   No   Unknown
Men Yes   No   Unknown
Women Yes   No   Unknown
Young Children Yes   No   Unknown
Older Children Yes   No   Unknown
Horses Yes   No   Unknown
Is the dog protective of its food? Yes   No   Unknown
If yes, please describe
Check all applicable behaviors  Digger    Climber    Chewer    Excessive Barker
Please describe if any were checked
Has the dog fought with any other dogs? Yes   No   Unknown
Has the dog ever injured or killed another animal? Yes   No   Unknown
If yes, please give details

Training Information

When on a leash, the dog: Pulls   Heels   Won't walk
Has the dog had any obedience training? Yes   No   Unknown
If yes, please give details and dates (if possible)
Is the dog housebroken? Yes   No   Unknown
If "Yes", how does the dog communicate this?
Please check the type of housing the dog has lived in Indoors
Basement
Garage
Fenced Yard
Kennel Run
Outside Tied up
Outside Loose
Unkownn
Is the dog destructive of property? Yes   No   Unknown
If "Yes", please give details
Is the dog crate trained? Yes   No   Unknown
Does the dog have a favorite toy, game or food?
How does the dog react to riding in the car? Quiet (settles easily)
Nervous (heavy panting)
Excitable (hyper and barking)
Agressive and protective of car
Please list any tricks or special skills your dog can do

Miscellaneous Information

Does the dog appear to be neglected, abused, or mistreated in any way? Yes   No   Unknown
If "Yes", please describe
Where does the dog spend the day?
Where does the dog spend the night?
Why do you want to put the dog up for adoption?
Describe your ideal home for this dog
Any additional information you'd like to share with Bull Terrier Rescue?
 
Please send all corrections and updates to:  Claudia Sharp