Bull Terrier Surrender Form

MRBTF Bull Terrier Surrender Form
If you wish to surrender your Bull Terrier to Maybell's Bull Terrier Rescue, please make sure you fill out this form in its entirety.

ALL FIELDS ARE REQUIRED! We understand that this is a very long, detailed form, but it is imperative that you provide us with as much information as you can. It will help further expedite your dog's case.
Contact Information
Your Name*
Email*
Daytime Phone*
Evening Phone
Address*
What is your relationship to the dog?*
Identifying Information
Dog's Call Name*
Dog's Registered Name
If not registered, please leave blank.
Dog's Date of Birth*
If unknown, please give approximate age.
Where did you acquire the dog?*
For example, was it a breeder, pet store, rehome, etc.
Are the dog's registration papers available?*

YesNoUnknown
Dog's Registration Number
Dog's Breeding History
If applicable, please include breeder, breeder's contact information, your dog's sire and dam.
Dog's Color*
Dog's Gender*

MaleFemale
Is the dog spayed or neutered?*

YesNo
Dog's Weight*
Describe the dog's mouth

OverbiteUnderbiteLevel/Scissor's BiteUnknown
Describe the dog's ears

ErectSoft
Describe your dog's nose

BlackPinkSpotted
Please describe any specific markings or scars.
Please check the form of identification. *

TattooMicrochipNone
Please provide the number and location of identification information.
Please include a photo of your dog.*

Upload a File

Cancelof
Medical Information
Does your dog have any allergies, medical conditions and/or required medications?*

YesNo
If so, please describe.*
Describe the overall mental and physical condition of the dog.*
Is the dog current on the following? Please check all that apply.*

Annual vaccinationsHeartworm medicationsRabies vaccination
Please explain.
Most Current Veterinarian Information*
Please include name, phone number and location.
Is the dog physically deformed in any way?*

YesNo
If yes, please explain.
Is the dog deaf?*

YesNoUnknown
Is the dog blind?*

YesNoUnknown
Please describe any hearing or vision problems.
What diet is the dog currently being fed? Please include specific brand.*
Please explain any allergies the dog may have, including dietary.*
Please describe the condition of the dog's teeth.*
Any other medical related comments.
Temperament Information
Please describe the dog's temperament, behavior, and personality.*
Has the dog ever bitten, or attempted to bite, anyone?*

YesNoUnknown
If so, please describe.
Is the dog good with:*

Male dogsFemale dogsCatsSmall animalsMenWomenYoung childrenOlder childrenHorses
Is the dog protective of their food?*

YesNoUnknown
If yes, please describe.
Check all applicable behaviors.

DiggerChewerExcessive barkerClimber
If checked, please explain.
Has the dog ever fought with another dog?*

YesNoUnknown
Has the dog ever killed or injured another animal?*

YesNoUnknown
If yes to either of the last two questions, please explain.
Training Information
When on a leash, the dog:*

PullsHeels and/or loose leashWon't walk
Has the dog had any obedience training?*

YesNoUnknown
If yes, please give dates and details (if possible).
Is the dog housebroken?*

YesNoUnknown
If yes, how does the dog communicate this?
Please check the type of housing the dog has lived in.*

IndoorsBasementGarageFenced YardKennel RunOutside Tied UpOutside LooseUnknown
Is the dog destructive of property?*

YesNoUnknown
If yes, please give details.
Is the dog crate trained?*

YesNoUnknown
Does the dog have a favorite game, toy, or food?*
How does the dog react to riding in the car?*

Quiet (settles easily)Nervous (heavy panting)Excitable (hyper and barking)Aggressive and protective of car
Misc. Information
Does the dog appear to be abused, neglected or mistreated in any way?*

YesNoUnknown
If yes, please describe.
Where does the dog spend the day?*
Where does the dog spend the night?*
Describe your ideal home for this dog.*
Any additional information you would like to share.
Should be Empty:

MRBTF Bull Terrier Surrender Form

Contact Information

Identifying Information

Medical Information

Temperament Information

Training Information

Misc. Information