Tesarz Services - Virtual Assistant
Surrender form for National English Shepherd Rescue
type of phone number
Home Land Line
Work Land Line
Please upload a picture of your dog
Max file size: 20MB
weight and height
Dog's coat color
Information on the Dog
Explain why you're are surrendering your dog
If your dog a purebred English Shepherd?
Purebred of unknown pedigree
Purebred of known pedigree
English Shepherd Mix
Breeder's name and contact information
If you are surrendering a purebred dog from known pedigree. Please give us the name and contact information of the breeder. Please state NONE if you did not get your dog from a breeder.
If Purebred have you contacted the breeder
Did you purchase this dog with a contract?
Did you purchase this dog from a breeder with a contract?
Please list vaccinations give and date.
Please list and explain any health issues your dog has.
Describe your dog’s temperament
Has your dog ever had a traumatic event that caused behavioral changes in your dog?
Is so please explain
Has your dog ever been aggressive to humans (including children), other dogs, live stock? If so please explain
Has your dog ever bitten a human?
If so please state the number of times and explain the circumstances surrounding each bite.
Any other information or comments
If we take your dog would you consider making a donation to defray the cost of retraining and rehoming your dog?
This isn't a requirement of us taking the dog
You will be contact within 48 hours after submitting this form by a representative of National English Shepherd Rescue.
©Tesarz Services 2004