First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Cell Phone*

What is your pet's name?*

For MARS dogs only What is the MARS tag number?

If you did not adopt from MARS where did your dog come from?

Breed(s) of the pet? Best guess*

Is your pet male or female?*

Animal's Age

Weight of the pet? (Your best guess if unknown)*

Is your pet spayed or neutered?*

Is your pet current on his/her rabies vaccination (This is mandatory for an assessment if we are able to proceed) and when was their last vet visit?*

Please describe any known health issues. (This does not determine acceptance or denial into our adoption program)

Why are you surrendering your pet? Please give details.*

Please describe your dog's personality

What does your dog’s typical day look like? *

Is the pet good with meeting new dogs or cats?*

How does your pet greet new people including children? (Details are helpful)*

How long has the dog been living with you?*

Does your pet currently live with:
Choose all that apply: Cats Dogs Kids Other

Please describe any known behavioral issues. (This does not determine acceptance or denial into our adoption program)*

Has your pet bitten in the last 15 days?*

If your pet has bitten in the last 15 days, what were the circumstances?

Any other information that you could provide to help us find an appropriate home for your pet? Please be as detailed as you can.