Surrender Form

Owner Information

Owner Name (required)

Owner Email (required)

Street Address (required)

City (required)

State (required)

Zip (required)

Telephone (required)

Alternate Telephone

Re-Home Dog Information

Your answers to the following questions will help rescue to find a home for your bulldog. Please be as detailed as possible and realize this is your chance to 'help determine' the best home for your bulldog.

Name of Dog (required)

Age of Dog (required)

Date of Birth

Gender
 Female Male

Altered
 Spayed Neutered Not altered

How Long Have You Owned This Bulldog?

Please upload any photos you may have of the dog needing re-homing

Microchip ID

Does Bulldog have any health issues?
 Yes No

If Yes, please explain

Does the dog have any special care issues with regard to weight, ears, teeth, eyes, tail or other?If Yes, please explain

Is the dog current with their shots (Rabies, DHLPP, Bortadella)?If not, when was his/her shots last updated?

Where is the dog kept during the day?
 Indoors Outdoors

How many hours per day is the dog alone?

Reason for Re-Homing Bulldog

If you are looking to re-home your dog because of medical issues, would you like to speak with one of our bulldog vets for a second opinion on care treatments that may allow you to keep your bulldog?

If you are looking to re-home your dog because of training issues, would you like to speak with one of recommended trainers about an evaluation and training program that may allow you to keep your bulldog?

Please understand that Southern California Bulldog Rescue is a network of volunteers which relies solely on donations for its operations. There is no Rescue owned or operated facility. Dogs are either fostered by our network of volunteers, or kenneled at a vet's office at Rescue's expense. As of now, we are beyond capacity with our foster homes. The average amount of time a dog is spending kenneled before adoption is 12 weeks.

How long are you prepared to still care for your dog until suitable foster or adoptive home is open?

Are you able to bring the dog to at least one adoption event each month for a couple hours so your dog an meet prospective homes?

Where or whom was dog obtained?
 Pet Store Private Party Rescue Shelter Breeder Other

If Other, Please Indicate

Has this dog has bitten or scratched anyone in the past 10 days?
 Yes No

Has this dog ever bitten a person or ever been in quarantine for biting?
 Yes No

Has this dog ever bitten another animal?
 Yes No

If yes, to any above, explain

Please use space below if you would like to provide additional information.

I agree

I Agree and Acknowledge by signing below that I own the above bulldog and am duly authorized to enter into this Re-Homing agreement. I am under no obligations with any other party concerning this bulldog. I agree to give this dog to Southern California Bulldog Rescue with the understanding that if no appropriate home can be found in the amount of time I am able to keep and continue caring for the dog, the dog will be placed in a foster home or kenneling facility where it will receive physical and medical care and then placed with a permanent adopter.

I am Re-Homing this dog of my own free will and understand that this can in no way be construed as a sale and that I will receive no money or any other consideration as a result of Re-Homing this dog. I understand that euthanasia may be deemed necessary due to severe suffering, uncorrectable aggression toward humans or similar circumstances.

I Agree and Acknowledge - Please Type Your Name (First & Last)

Rescue relies solely on donations to provide medical care, food and kenneling for surrendered bulldogs. Should your dog be accepted by the bulldog rescue program, surrendering homes are expected to provide dogs with some financial assistance since the family will no longer have the expense of feeding and caring for the dog in their home. So Cal Rescue does not get any government support and can only rescue bulldogs that the program can afford to help.

I would like to assist Southern California Bulldog Rescue with a donation for costs incurred by my bulldog entrusting to Rescue to Re-Home.
 $ 100 $ 125 $ 150 $ 175 $ 200 $ Other

 Yes No I request wavier of providing assistance for this bulldog based on the following.

Rescue relies rely's solely on donations for its operations. We do require a Re-Homing assistance donation, based on circumstances:

Please bring your donation, the dogs bed, crate, leash, collar and any current medications that your bulldog would need.
If you are surrendering an elderly bulldog or a bulldog with special needs, there is a high likely hood you bulldog will be in rescue for several weeks. For those bulldogs, we offer a month sponsorship program and will provide you with updates on the status of bulldog until placed. You monthly support would be used to help cover the food and care expense of your bulldog.

Bulldog Personality

Help us find a home, where do you think your bulldog would be happiest?Please describe the ideal home for your bulldog.

Adjectives that best describe your bulldog

Check all that Apply
 Active Affectionate Aggressive Calm Friendly Goofy Nervous Noisy Obedient Playful Protective Quiet Shy Smart

Is Bulldog Housebroken?
 Yes No

Are there any training or behavior problems? If so what are they?

Does Bulldog get along with?
 Dogs Cats Other Animals Unknown

Does bulldog like/get along with children
 Yes No Unknown

What BRAND of dog food is Bulldog fed?

Is dog food:
 Kibble (dry) Canned Semi-Moist Combination Raw

Where does Bulldog sleep?

Is Bulldog crate trained?
 Yes No Unknown

Has Bulldog had any training?

Does the Bulldog like riding in the car?
 Yes No Unknown

Veterinarian Records & Information

I hereby give permission to Southern California Bulldog rescue to acquire all medical records needed from veterinarians, medical offices and former owners of bulldog upon written request. My signature acknowledges that Rescue will obtain records needed for providing future care for bulldog.

Veterinarian Name/Office

Street Address

City

State

Zip

Phone

If more than one Veterinarian, please list information below

How did you hear about Southern California Bulldog Rescue?
 SCBR Website PetFinder.com Adopt-A-PetVeterinarian (please indicate below) Newspaper (please indicate below) Friend (please indicate below) Shelter (please indicate below) Previous Adopter of SCBR (please indicate below) Other (please indicate below)

Please Indicate Other Information Here

Signature Waiver:
I agree that by typing my name below, that I have read and understood the conditions of this contract. Furthermore, I agree to abide by the terms of this contract.

Signature (required)

Month (required)

Day (required)

Year (required)

Your Message

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