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Please answer the questions honestly and be as detailed as possible. This will help is in determining if we will be able to accept your dog in to our rescue. This information MUST be submitted along with a photograph before we will consider accepting your dog in to our program. If you have made the difficult decision to surrender your dog, the following steps apply:

Your Name

Email

Date

Breed

Gender

Altered, if yes please explain:

AKC#: (if Applicable)

Color

Microchip or Tattoo#:

Dog's Name:

Dog's Age:

Address

Phone

I would like to find my bulldog a home by the following date:

Reason for Surrender:

Has the dog ever been Bred:

Has the dog been Injured:

Does the dog have any known medical conditions (i.e. allergies, seizures, etc.)?

Has the dog been Spayed or Neutered

Is the dog current on vaccinations (shots)?

Veterinarian Name:

Veterinary Address:

Street address, P.O. box, company name, c/o

City

State / Province / Region

Postal / Zip Code

Country

Veterinary Phone Number:

Where does the bulldog live?

Urban

Rural

Farm

Suburban

Does the bulldog live in:

House

Condo

Apartment

Garage

Outside

If the dog is an inside dog, where does it sleep?

Bed

Owners Bed

Crate

Floor

Couch

Cellar/Basement

Is the dog aggressive towards people?

If Yes to above question, please explain:

Has the bulldog been around large dogs, small dogs, cats, birds or livestock?

Is your Bulldog an only dog or in a multiple dog household?

List the age, sex, type of other dogs/ cats in household:

How many hours is the bulldog used to being left alone during a normal day?

Brief Periods

Less than 6 hours a day

6-8 hours a day

Longer than 8 hours a day

Is the Bulldog Housebroken?

Is the bulldog crate trained?

How is your bulldog exercised?

Leashed Walks

Fenced Yard

Couch Potato

Fetch

Please describe the temperament of the bulldog

Does he/she enjoy car rides?

Is the bulldog handshy?

Please list anything the dog is afraid of (i.e. loud noises, men, women, veterinarian, vacuum, broom, thunder, cars, people in uniform, fireworks, sirens, children)

Does the bulldog spook easy?

Please list items you will be sending with the bulldog (i.e. toys, food, collar, leach, crate, dog beds, vet records, AKC papers):

Please list bad habits or behavioral problems that the bulldog has (i.e. chews furniture/ clothing/ shoes, jumps fences, bites, separation anxiety, digs holes, barks excessively, counter surfs, overprotective):

Please note that a $75 minimum donation is required:

I certify that I am the legal owner of the dog described above and warrant and represent that this dog has never shown signs of aggression towards human beings and further warrant and represent that this dog has not bitten me or any other individual while in my possession. I am the sole owner of the above described dog and that other parties have a legal interest in this dog. I relinquish all rights, interest and ownership of the above dog to Illinois English Bulldog Rescue (IEBR) and hereby relinquish all claims to said dog. I understand that this surrender is irrevocable and ownership of the dog is now relinquished to Illinois English Bulldog Rescue (IEBR). By E-signing this form, i hereby certify that i have honestly answered all of the above questions, to the best of my knowledge.

Photo of the dog

Your form has been submitted. Thank You!