Surrender Application - Bullie Buddies of Las Vegas

Animals are a lifetime commitment; they are not disposable.

Bullie Buddies of Las Vegas - Owner Surrender Form

Please complete this form in its entirety. This is not a Surrender Contract, this is just preliminary information that you are sending us about your dog and submitting the form neither guarantees that we will be able to accept your dog or binds you in any way to surrender your dog to us. We will need a photo of the dog, which you can e-mail to us separately at info@bulliebuddieslv.org with the subject line "Owner Surrender: [Dog's Name]."

**The dog must be spayed/neutered and up to date on vaccinations. We will require the vet records. For Clark County residents - your pit bull can be altered for free and low cost vaccinations are available at several locations.**

Your Full Name
Are you the legal owner of the dog being surrendered? Yes No
What state do you live in?
Your E-Mail Address
Home Phone Alternate Phone
What is the breed of dog that you are surrendering? American Pit Bull Terrier, purebred American Staffordshire Terrier, purebred Staffordshire Bull Terrier, purebred Pit Bull Mix (any of the above mixed with another breed)
What is the age of the dog?
Gender: Male Female		Is the dog spayed/neutered? Yes No
Is this dog current on vaccinations? Yes No I don't know.
Does the dog have any health issues? (Answering yes does not mean the dog will not be accepted into rescue - please answer honestly) Yes No
If you answered Yes to the above, please explain what health issues the dog has. Please be specific.
Is the dog aggressive towards other dogs? Yes No I don't know.
Is this dog aggressive towards cats or other small animals? Yes No I don't know.
Has the dog exhibited any aggressive behavior towards humans? Yes No
Please explain why you wish to surrender your dog to a rescue:
If your dog is accepted into our rescue program, are you able to keep the dog (Owner Foster) while he/she is up for adoption? Yes No
By submitting this form I certify that I am the legal owner of this dog. I understand that there is no guarantee this dog will be accepted into the Bullie Buddies of Las Vegas rescue program. I agree that, should my dog be accepted into the rescue, I will make him/her available to meet prospective adopters and for adoption day events. Yes, I agree

Bullie Buddies of Las Vegas
7435 S Eastern Ave. #5-276
Las Vegas, NV 89123

702.845.3393

info@bulliebuddieslv.org