Please answer the following, to help us find a suitable home for your pet.

Name of Dog:___________________ Sex______________ Spayed/Neuter?_______

Vaccinations: Type:______________ Date_____________

If known: AKC Papers______________ Date of Birth_______ Age________________

Breed of Dog ----------------------------------------------------------------------------------------------------------------

How long have you owned this dog _______________________________________________

Where did you get this dog______________________________________________________

Why are you surrendering this dog________________________________________________




What are this dog’s likes and dislikes (cat friendly, likes kids) ____________________________


What type of training does this dog have (obedience, sit, stay, leash trained) ________________


Has this dog ever bitten anyone, or another animal ____________________________________

Was this dog indoors or outdoors________________Is the dog house trained______________

What type of fencing is the dog used to ____________________________________________

Where does the dog sleep __________________ Is the dog allowed on the furniture__________

Is the dog crate trained______________________ Is the dog used to being in a kennel _______

What is the name of your veterinarian_____________________ Is the dog on any medications

or under any prescribed care________________

What brand of food does your dog eat__________________________________________________________




I, _________________________________________, declare that I am the sole owner of this animal, named ___________________________, and agree to relinquish this animal and all claims and ownership of said animal to Colville Pet Rescue (CPR).


________________________________________ __________________

Name Date




City State Zip Code

_______________________ ______________________________________

Phone Email Address