Surrender Information

Let Us Help You to Keep Your Pet During Tough Financial Times!

Your Main Email Address (enter only one valid email address): *

Enter alternate email addresses here:

A RECENT picture of your dog is needed before we can accept him/her into rescue. Please e-mail a picture immediately after submitting this form to robin@smallpawsrescue.org. Until we receive a recent picture of your dog, your request can't be processed. *

Yes I will send a picture - Initial and Date Yes I will send a picture - Initial and Date

Your First Name: *

Your Last Name: *

Your City AND State? (Without your city AND state we can't process this request). *

Name of Bichon/BichonMix in need of rescue: *

Is this dog a Bichon or Bichon Mix? *

Yes

No/Other No/Other

Dog's age: *

Sex of dog: *

Male

Female

How much does this dog weigh? *

Where did you originally get this Bichon? *

Has this dog been Spayed or Neutered? *

No

Yes

Don't Know Don't Know

Can you tell us why this dog needs to be rehomed?

Your phone number and the best times to reach you? *

Your relationship to the dog? *

Owner

Relative of Owner

Friend of Owner

Found the dog

Other Other

Housetrained? *

Has this dog ever bitten? *

If yes, how many times?

Have you sought out help from your vet or behaviorist about this problem?

Is this Bichon good with children? *

Does this dog get along well with other dogs? *

Yes

No

Is it necessary for this dog to be placed as an only dog? *

Yes

No

We need your veterinarian's name and phone number. Without that information your request won't be processed. We need to be able to determine legal ownership of the dog.

Vet's Name:

*

Vet's Phone Number *

I give permission for SPR to contact my veterinarian and to get a copy of my dog's vet records. (Please enter your initials and date your yes answer.) *

No

Yes Yes

Tell us a little about this Bichon's health: *

A RECENT picture of your dog is needed before we can accept him/her into rescue. Please e-mail a picture immediately after submitting this form to robin@smallpawsrescue.org. Until we receive a recent picture of your dog, your request can't be processed. *

Yes I will send a picture - Initial and Date Yes I will send a picture - Initial and Date

I understand that after surrender, my Bichon may be flown via the commercial airlines to their new foster/adoptive home in another part of the country.
Initial and date: *

Is this Bichon or Bichon Mix safe for the time being?

*