Name of Dog Owner(s)
Sex of Dog
Age of Dog
Date of Birth of Dog
Microchip Co. and #
Why is the dog being given up?
Date of Last Rabies Inoculation
Is the dog currently on any medication? (please list if ‘yes’)
Name and Location of Veterinarian
Is the dog house-trained? If ‘no,’ please explain:
Has the dog ever bitten anyone?
Is the dog good with children?
Does the dog get along with other dogs?
Is the dog crate trained?
Where does the dog normally sleep?
Is the dog food aggressive?
Are there any ‘commands’ the dog knows?
I hereby acknowledge that I have read and understand the above terms and conditions, and that all information provided herein is complete, accurate and true to the best of my knowledge. I agree to a donation to GreenDog Foundation to cover the care and possible medical expenses incurred.
Donation Amount ($)
Your Full Name