911RUFF.org Turn-In Form

Please use this form if you wish to turn in a dog to RUFF.

Did you get the dog from RUFF? Yes No
Why are you putting your pet up for adoption?
Owner's Name * First Last
Owner's Age
Owner's Email *
Owner's Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Owner's Home Phone * - (###) - ### ####
Owner's Cell Phone - (###) - ### ####
Breed of Dog (Please Do NOT Put Mutt or Mixed):
Pet's Name:
Do you know the dog's birth date? Yes No
If yes, what is the dog's birth date? / MM / DD YYYY
Approximate Age:
Where did you originally get the dog? *
How long have you owned this dog?
What is the dog's gender? Male Female
Is the dog spayed or neutered? Yes No Unknown
Is the dog housebroken? Yes No
Dog's Weight (lbs):
Dog Breed:
Dog Color(s):
Any special markings? Yes No
If yes, what is/are the special marking(s)?
Any known fears? Yes No
If yes, what is/are the known fear(s)?
Basic obedience training? Yes No
Leash trained? Yes No
Any special likes? Yes No
If yes, what is/are the special likes?
Any special tricks or commands? Yes No
If yes, what is/are the special tricks or commands?
Any bad habits? Yes No
If yes, what is/are the band habits?
Does the dog have favorite games or toys? Yes No
If yes, what is/are the dog's favorite games or toys?
Check the term(s) that best describe(s) your pet: Friendly Destructive Timid Shy Obedient Playful Aloof Finicky Demanding Unruly Loves Everyone Submissive Lazy High Energy Temperamental Digs
Dislikes children? Yes No
Dislikes men? Yes No
Dislikes women? Yes No
Does your pet get along with other dogs? Yes No
Where has your pet spent most of its time? Indoors Outdoors
Has your pet been confined (kennel, chained, fence, etc)? Yes No
What brand of dog food does your dog eat?
What type of food is it? Wet Dry
Is your pet current on all vaccines? Yes No
Is your pet current on heartworm preventative treatment? Yes No
When was the last heartworm preventative treatment? / MM / DD YYYY
Where did you purchase heartworm preventative treatments?
Is your pet current on flea preventative treatment? Yes No
When was the last flea preventative treatment? / MM / DD YYYY
Where did you purchase flea preventative treatments?
Any other health problems or anxiety problems we need to know about? Yes No
If yes, what is/are the problem(s) or anxiety(s)?
What is the name/number of your veterinarian so that we may request the animal's health records?
Is there a Microchip? Yes No
Please check the box to authorize the release of veterinarian records - this form will not submit without this authorization. * I authorize the release of my veterinarian records.
Items we need you to bring in when you bring in the dog: proof of rabies certificate, proof of other shots, and the signature microchip form turn over sheet (if microchipped). This form will not submit without your agreeance. * I will provide these.
If you have a photo of the dog that you can upload, please upload it below. If you do not, once a photo becomes available, please email it to janice@911ruff.org