Surrender Application | Premier Truffles

First name

Last name

Email

Phone

Address

Best Method to Contact

Phone

Text Message

Other:

Are you the legal owner of this dog?

Yes

No

If No - please explain

Have you contacted your breeder?

Yes

No

Breeder Name

Dogs Registered Name

Everyday name your dog goes by

AKC Registration # (if applicable

Microchip #

Date of Birth/Age

Sex

Male

Female

Spay/neuter

Spayed

Neutered

Color

Weight

Is the dog current on vaccinations?

Yes

No

Has the dog ever had adverse reactions to vaccines?

No

Yes

If Yes - please explain

Veterinarian Name & Contact

Has the dog had any significant medical diagnoses, surgeries, or ongoing conditions?

Include medications, allergies, injuries, or neurological concerns

Temperament & Behavior

How would you describe your dog's personality?

How does your dog respond to the following

Strangers

Children

Other dog's male/female

Cats or small animals

Check box if there are issues

Please elaborate on responses

If yes to any of the above, please explain fully

Is your dog

Crate Trained

House Trained

How many hours is your dog typically left alone

Describe the dogs training background

Obedience scent work, hunting, sport, etc.

Reason for Surrender

How long have you been considering this decision?

What steps have you taken to resolve the situation before deciding to surrender?

Is there a deadline by which placement must occur?

If yes, please explain

Fence Type & Height

Has the dog lived primarily

Indoors

Outdoors

Legal & Ethical Agreement By submitting this form you acknowledge :

You are the legal owner and have the authority to surrender this dog.

You agree to provide full medical and behavioral disclosure

You understand that Premier Truffles may decline intake based on capacity or suitability

You understand that surrender fees may apply to assist with veterinary care and evaluation

Signature & Date

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Premier Truffles

Lagotto Romagnolo • Dog-Found Truffles • Oregon Coast

Lagotto Surrender Form

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