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2. Date*
   Date

   Date
3. Animal Name*
4. Animal Breed(s)*
5. Animal Age*
7. First Name*
8. Last Name*
10. Email*
11. Phone Number*
12. Secondary Number
14. Address*
16. City*
17. State*
18. Zip Code*
20. How long have you had this dog?*
22. How was the dog kept during the daytime?*

    1. Indoors
    2. Outdoors
    3. Both Indoors and Outdoors
24. How was the dog kept during the night?*

    1. Indoors
    2. Outdoors
    3. Both Indoors and Outdoors
26. How does the dog act towards men?*
28. How does the dog act towards women?*
30. Did the dog live with children?*

    1. Yes
    2. No
31. If so, how does the dog act towards children?
32. Ages of children:
34. Is the dog friendly with other dogs?*

    1. Yes
    2. No
    3. Unknown
36. Is the dog friendly with cats?*

    1. Yes
    2. No
    3. Unknown
38. Does this dog chase or harm any livestock animals? Ex: chickens, goats*
40. Does this dog chase or harm any small creatures? Ex: rabbits, squirrels*
42. Is the dog housebroken?*

    1. Yes
    2. No
    3. Partially Housebroken
    4. Unknown
44. Does the dog exhibit resource guarding? Ex: Guards toys or food*

    1. Yes
    2. No
    3. Unknown
46. Does the dog play with toys?*

    1. Yes
    2. No
    3. Unknown
48. Does the dog walk well on a leash?*

    1. Yes
    2. No
    3. Unknown
50. Is the dog obedience trained?*

    1. Yes
    2. No
    3. Some Training
    4. Unknown
52. Does the dog escape? Ex: Digging out, climbing, dashing out doors*

    1. Yes
    2. No
    3. Unknown
54. What brand of dry food does the dog eat?*
56. Does the dog have any other specific behaviors or issues?*
58. Why can you no longer care for this dog? *
60. Additional Comments:
62. Veterinarian:*
64. By signing below, I certify that I realize by surrendering my pet to Oconee County Animal Services it becomes the property of the county.
66. By signing below, I certify that this animal has not bitten or scratched any person within the last 10 days.
68. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
70. First Name*
71. Last Name*
73. Electronic Signature*
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit Submit and Print

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