Surrender Form

1FBV Surrender Form > 2FBV Surrender Form Cont'd > 3Review Your Entry
Date of Application Date of Application / MM / DD YYYY
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####
Email
Dog's Basic Information
Tell us why you are surrendering the dog:
Dog's Name
Sex of the dog?

Sex of the dog? Male Female
Is the dog altered?

Is the dog altered? Yes No Unknown
Color of the dog?

Color of the dog? Cream Fawn Brindle Black Masked Fawn Honey Pied (white w/cream spots) Fawn Pied (white w/fawn spots) Brindle Pied (white w/brindle spots) Reverse Brindle Other Other
Dog's weight
Dog's age?
Dog's Birth Date, if known Dog's Birth Date, if known / MM / DD YYYY
Where did you get the dog?

Where did you get the dog? Breeder Craigslist Shelter / Rescue FBV Other Other
If the dog is from a breeder or rescue, please provide their name.
Dog's Medical Information
Current Vet's Name
Vet's Phone Vet's Phone - ### - ### ####
Is your dog current on vaccinations?

Is your dog current on vaccinations? Yes No Unknown
Does your dog have any ongoing or previous medical issues? For example: allergies, ear infections, skin infections, etc. Please be as truthful and objective as possible. We often do take in dogs with medical issues. It is important that we know as much information as possible in order to place your dog in a foster home that is best suited to meet his needs.

Does your dog have any ongoing or previous medical issues? For example: allergies, ear infections, skin infections, etc. Please be as truthful and objective as possible. We often do take in dogs with medical issues. It is important that we know as much information as possible in order to place your dog in a foster home that is best suited to meet his needs. Yes No
If you responded yes to medical issues, please describe medical issue(s) below along with any medications your dog is currently taking. Again, please be as truthful and objective as possible.
**To expedite the intake process, please have all vet records sent to intake@frenchbulldogvillage.org. Vet records are required. If you do not have any, please explain why.**
Is your dog microchipped

Is your dog microchipped Yes No Unknown
If yes, please list the microchip number:
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

Surrender Form

Surrender Form

Dog's Basic Information

Dog's Medical Information