Name:

Address:

City, State, Zip:

Email Address:

Home Phone:

Cell Phone:

Work Phone:

Dog Information

Dog's Name:

Dog's Sex:

Is this dog spayed or neutered?

Dog's Age and Date of Birth (if known):

Dog's Weight (if estimating, please be as accurate as possible):

Dog's Color:

Temperament Information

Please be as honest in your answers to the following questions.

Is this dog accustomed to and used to children?
Please explain:

Is this dog accustomed to and used to other animals?
Please explain:

Please describe this dog's overall temperament:

Has this dog ever bitten anyone?

Has this dog ever attempted to bite anyone?

Has this dog ever shown aggressive, violent, or inappropriate behavior?

If you answered "Yes" to any of the above questions, please use this space to describe the circumstances:

Veterinary Information

Vet or Clinic's Name:

Vet's Address:

Vet's City, State, Zip:

Vet's Phone Number:

Is this dog's vaccinations current?

Date of last vaccinations, if known:

Has this dog been on heartworm preventative?

About the Surrender

Please describe all pertinent details of how the dog came to the attention of The Rottweiler Project. (for instance, where the dog was found, why the dog is being surrendered/ how the dog was found, etc.)

Please describe the physical condition of the dog. (For instance, general health, coat condition, general fitness, etc.)

Are there any conditions that may need veterinarian treatment. If so, give description (i.e. cherry eye, mange, etc.)

Is this dog adoptable in your opinion? Explain why.

Is there any other information that you can provide that will help rescue find the right home for this dog?