Step 1 of 5 20% If this is an emergency surrendering of the pug, please contact us by phone at 1-888-509-1940 (toll-free). A volunteer will contact you as soon as possible. We want this transition to be as painless and easy as possible for you and your pug. Please do not hide any medical conditions or behavioral problems from us. Honesty is the best policy! The information given in this form will be used to assist us in the proper course of medical treatment and in finding the proper foster family, until we find their new forever home.How urgently do you need to place the pug in our care?* I need to place my pug into foster care in the next 3-4 days I need to place my pug into foster care in the next 5-7 days I need to place my pug into foster care in the next two weeks I need to place my pug into foster care in the next month I can wait longer than 30 days to place my pug into foster care We will work as quickly as possible to take the pug into our foster care program, but your flexibility is appreciated. Your response is only a guide that will help us to prioritize the pugs needing rescue.Your Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Alternate PhoneEmail Address* Are you surrendering your own pug? Yes, this is my own pug I am surrendering a pug on behalf of a family member I am surrendering a pug on behalf of someone else I am surrendering a stray pug I found I am surrendering a pug on behalf of an organization or shelter Why are you giving up this dog?Pug Partners understands that there are many reasons owners give up their dogs from health reasons to behavior problems with the pug. Please answer honestly and openly so we can provide the best assistance. Pug's General InformationThis information will help us to place the pug into an appropriate foster home. Please include as much information as you are able to provide.Pug's Name Pug's Gender Male Female Pug's Age (can be approximate) Pug's Date of Birth (if known) Month Day Year Color Fawn (Tan) Black Apricot Brindle Other A current photo of your Pug is required before we will proceed with your request. If you are not able to get the photo to upload via this form, please email the photos to info@pugpartners.com.Please attach a picture of the pug you are surrendering.Accepted file types: jpg, jpeg, png, gif.Please attach another picture of the pug you are surrendering.Accepted file types: jpg, jpeg, png, gif.How long have you had this dog? City/State where the pug was obtained: Are you the pug's original owner? Yes No If No, please explain any known history: Pug's Medical InformationYour answers about your pug's medical condition do not affect our decision to place this dog in foster care. It helps us choose the foster home best equipped to provide any necessary medical care. It will also allow us to give the pug immediate treatment of any known medical conditions.Do you have a veterinarian that you see for this pug? Yes, I have a veterinarian No, I do not have a veterinarian No, I found this pug I don't know, I'm helping someone else surrender this pug Name of Veterinarian/Clinic First Last Please provide your pug's veterinary information. By providing this information, you are giving Pug Partners of Nebraska permission to obtain your pug's medical records.Veterinarian's Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Veterinarian's Phone NumberDate of last visit to vet: Is this pug spayed or neutered? Yes No Not Sure Is this dog microchipped? Yes No Not Sure Please provide microchip company information and registry number: Do you know when this pug last received his/her vaccinations? Yes, I know the dates of latest vaccinations No, I do not know the dates of latest vaccinations Date last vaccinated for Rabies: Date last vaccinated for Bordetella: Date last vaccinated for Distemper/Parvo: Date of last fecal test: Date of last Heartworm test: When was the last dental cleaning done? Is this pug currently on Heartworm preventative? Yes No Not Sure If yes, please list date last Heartworm preventative was administered and brand name: Does this pug require immediate medical attention? Yes No I don't know, I found this pug I don't know, I am helping someone else surrender this pug Please list and describe the condition requiring immediate medical attention.Has this pug ever been diagnosed with a medical condition? Yes No I don't know, I found this pug I don't know, I am helping someone else to surrender this pug. Please list and describe the condition as well as the prescribed course of treatment, including all medications or surgeries required to treat this medical issue, as well as any limitations to diet or mobility.Has this pug ever had surgery other than a spay or neuter? Yes No Not sure Please describe surgeries performed on the pug other than a neuter or spayDoes this pug sufer from allergies? Yes, severe allergies Minor allergies No allergies that I am aware of Not Sure Is this pug taking any medication currently? Yes No Not Sure Please include any supplements you are giving to your pug as well.What kind of medication, what dosage and for what reason?Prior to accepting your pug in rescue, you will be asked to provide any vet records you have for your dog - especially for their latest vaccinations, any health issues, proof of spay/neuter, etc. You can either provide printed copies or upload a file below.If you have the medical history (even partial), please scan and save to your computer and upload it here.Max. file size: 300 MB. Feeding InformationWhat type/brand of food do you currently feed this pug? Does the pug exhibit any food aggression? Yes No Not Sure If yes, please explain TrainingHousetraining Yes, pug is housetrained No, pug is not housetrained Needs housetraining reinforcement Not Sure Marking The pug does not mark his/her territory in the house Pug may mark in the house, may have to keep an eye on him/her The pug marks all the time Marks when other dogs are around. I do not know, I found this dog. I do not know, I am helping a friend surrender this dog. Please check all that applyDescribe prior obedience training and commands the dog has been trained to obey (e.g. “down” “stay”)Human & Animal InteractionIs this pug good with children? Pug is good with all children Pug is only good with children over the age of 5 Pug does not like children of any age Pug has snapped at a child in the past Pug only likes girls Pug only likes boys Unsure, the pug has never really been around children I don't know, I found this pug I don't know, I am helping a friend surrender this pug Please check all that applyIs the pug good with other dogs? Yes, the pug loves all other dogs The pug needs time to adjust to other dogs. The pug does NOT get along well with large dogs. The pug is aggressive towards Female Dogs The pug is aggressive towards Male Dogs I don't know, the pug has never been around other dogs The pug prefers to be the King/Queen of the Castle, so another dog in household would NOT be good I'm not sure, I found this pug I'm not sure, I am helping someone else surrender this pug Please check all that applyIs the pug good with cats? The pug gets along well with cats The pug does NOT get along well with cats I don't know, the pug has never been around cats I don't know, I found this pug I don't know, I am helping someone else surrender this pug Please check all that applyHas this dog ever bitten anyone? Yes No Not Sure Please Explain:RoutineFavorite toys/games/treats: Approximately how many hours per day (on average) is this dog being left alone? 1-3 3-5 5-8 8+ Not Sure Where does the pug typically stay when the owner is not home? Crate Loose in the house Confined to one area Outside Not Sure Will the pug allow you to: (check all that apply) Hold him Groom him Pet him Trim his nails Wash his face Clean his ears Is there anywhere the pug does not like to be touched? Yes No Not Sure If yes, please explain: Does this pug suffer from anxiety? No anxiety issues May bark if left alone May cry if left alone May whine if left alone The pug will chew furniture or other items if left alone. The pug may have accidents in the house if left alone You may choose more than onePlease explain any behavioral issues this pug has exhibitedIs this pug crate trained? Yes No At night During the day while I am at work Don't really know. You may choose more than oneWhere is the pug used to sleeping? In bed In his/her own bed In a crate Don't know Please select all that applyPlease choose the items that you can provide/send along with the pug. Doggie Bed Water & Food bowl Blanket Crate Leash Collar/ Harness Please select all that you would be willing to send along with the pugHelpful InformationWhat are your pugs’ best qualities?How is this pug best disciplined?What kinds of naughty things does the pug do that you’ve needed to discipline for? (ex. getting in the trash)Personal HabitsPlease check any that APPLIES to your pugPersonal Habits (Check ALL that apply to your pug) Crate trained A barker Get up on furniture Ride well in car EVER bit anyone Toy aggressive Leash trained A digger Sleep in bed at night Chews household items Marking inside If you had to use TWO of the following words ONLY, how would you describe your pug? Submissive Dominant Affectionate Aggressive Fearful Confident Skittish/Shy Nervous/Neurotic Lazy/Couch Potato Independent Stubborn Friendly/Social Anxious Hyper Does your pug panic when left alone (i.e., barking, pawing at blinds or under doorways, scratching on doors, escaping, vocalizing and otherwise manifesting high [separation] anxiety)? Yes No Sometimes Not Sure Does your pug bolt out the door, jump or escape often? Yes No Not Sure Is there anything else we should know that will help us in placing your pug?This is a service to help place pugs in new homes when their present owners can no longer keep them. This service is free, however a donation to help pay for expenses is appreciated. All donations are tax deductible and you can donate online through our website (www.pugpartners.com) or by check (Made out to ‘Pug Partners'). Would you be willing to donate? Yes No If so, what amount are you willing to donate? PLEASE READ, SIGN AND DATE THE FOLLOWING:By signing below you signify that you understand the following: It may take up to 48 hours for a volunteer to contact you. Pug Partners of Nebraska is staffed exclusively by volunteers, most of whom have full time jobs and families. Every effort is made to transition pugs into foster care as quickly as possible but we do ask for your patience and flexibility as we work to make suitable arrangements for the pug. In order to minimize the impact of the transition on the pug, we ask you surrender all of the pug’s belongings (bedding, toys, crate, leash, food, medicines, ect.) Completion and electronic signing this document relinquishes ownership of the pug(dog) to Pug Partners of Nebraska. Once Pug Partners personnel take the pug into their care, returning of the pug to the former owner is done only under the discretion of Pug Partners personnel.I do hereby relinquish custody of the dog(s) listed above and do turn over ownership of said dog(s) to who is representing Pug Partners of Nebraska Rescue. I understand and agree that Pug Partners of Nebraska will assume responsibility for placing the dog in foster care until permanent placement is arranged. By signing this agreement, I relinquish all rights to this dog. I understand that I no longer own this dog, therefore any medical expenses that are incurred on or after the surrender date are the responsibility of Pug Partners of Nebraska. I authorize the veterinarian(s) listed herein to release all medical records concerning the dog to Pug Partners of Nebraska. I understand that my name, address, and phone number will not be released by Pug Partners of Nebraska to anyone unless I specifically authorize it.Signature* Today's Date* MM slash DD slash YYYY Δ
