Surrender Form
Questions marked by * are required.
1. Your First and Last Name *
2. Street Address *
3. City *
4. State *
5. Zip Code *
6. Your Phone *
7. Your Email *
8. Pug's Name *
9. Pug's color *
  • Fawn
  • Black
10. Pug's Sex *
  • Female
  • Male
11. Pug's Age - years *
12. Spayed or Neutered? *
  • Yes
  • No
  • Unsure
13. Is your pug a pure breed? *
14. If your pug is a mix, what is it mixed with (please guess if unsure)?
15. Have you made the final decision to surrender the Pug? *
16. How long have you had your pug? *
17. Where did you get your pug? *
18. Are you the legal owner of this pug? *
  • Yes
  • No
19. If you are not the Legal Owner, please explain:
20. Reason for Surrendering (check all that apply): *
  • New Baby
  • Allergies
  • Not home enough/Not enough time
  • Moving and cannot take the dog
  • Found as stray
  • Behavior issues
  • Health Issues - owner
  • Cannot afford care
  • New Home
  • Other
21. If your answer above was Other, please describe
22. Please select any health problems(we do not turn away pugs due to health problems)
  • Eye problems
  • Ear Problems
  • Breathing problems
  • Heartworm Positive
  • Lyme Positive
  • Pancreatitis
  • Seizures/Epilepsy
  • Arthritis/Joint Problems
  • Paralyzed
  • Mange
  • Pug Encephalitis
  • Cancer
  • Blind
  • Deaf
  • other
23. If you answered Cancer or other, please give some additional information.
24. Please select any behavior problems(We do not turn away Pugs due to behavior problems.)
  • Agressive Towards Other dogs
  • Aggressive Towards Cats/Other Small Animals
  • Aggressive Towards Children
  • Aggressive Towards Adults
  • Barks Excessively
  • Destructive
  • Escapes from Fence
  • Guards Food
  • Guards Toys/Other Possessions
  • Guards People
  • Hyperactive
  • Other
25. Please describe behavior problems
26. Is your pug housebroken? *
  • Yes
  • No
  • Partially
  • Unsure
27. If you answered Partially, please explain.
28. Is your pug crate trained? Where does your pug stay when you are not at home?
29. To help with your pug's transition, please tell us about his or her daily routine. Any special likes or dislikes?
30. Current Vet Name *
31. Current Vet Phone
32. Date of last shots *
33. Is you pug on monthly heartworm prevention? *
  • Yes
  • No
34. When was the last dose given? *
35. Other Medications *
36. We can take the dog into rescue much more quickly if you are able to provide some transportation assistance. Are you able and willing to help by meeting our volunteer part of the way? *
  • Yes
  • No
37. We will work quickly to take your pug into foster care but your flexibility is greatly appreciated. Please indicate how urgently you need to place the dog in foster care. Your response to the item below is only a guide that will help us prioritize your needs. Please remember we use Volunteer foster homes and how quickly placement into rescue is based on availability of an open Foster home at the time of your request. Pure bred pugs will take priority over pug-mixes because the majority of our adopters want a pure bred pug when they come to us. When our foster homes are full, the wait time for a pug mix could be 60-90 days. *
  • Emergency
  • 1-2 Weeks
  • 2-3 Weeks
  • 3-4 Weeks
  • 4+ weeks
38. If you are able to help with transport, how far are you willing to travel? *
39. Additional comments
40. How did you learn about DFW Pug Rescue? *
  • Internet
  • Friend Referral
  • Vet Referral
  • Event
  • Other
41. By selecting Agree, you signify that you understand the following: It may take up to 48 hours for a volunteer to contact you. DFWPRC is staffed exclusively by volunteers. Every effort is made to transition pugs into foster care as quickly as possible but we ask your patience and flexibility as we work to make suitable arrangements for your pug. To minimize the impact of transition, Vet records and current medications are essential in ensuring that the pug receives proper medical care. Please make arrangements to obtain a copy of these records from your vet. Please be aware that upon selecting agree and surrendering the pug to a DFWPRC volunteer or to a DFWPRC vet clinic, you are granting DFWPRC legal ownership of the pug. *
  • I Agree
  • I Do Not Agree