Shelter, Rescue, Breeder Transfer

Shelter, Rescue, or Breeder Transfer

First name

Last name

Organization Name

Position

Email

Phone

Address

Name of dog

Is the dog a Cavalier King Charles Spaniel? If it is a mix, please indicate other breeds and percentages if you know. If you are not sure, please indicate that.

Does the dog have a pedigree? If so, please provide HCC a copy.

How did you gain possession of the dog?

When did you gain ownership of the dog?

What color is the dog?

ruby

blenheim

tricolor

black and tan

Please list age of the dog, if known. If it is an estimate, please indicate that.

Gender

unaltered male

neutered male

unaltered female

spayed female

If the dog is an intact female, please note date of last heat cycle.

How does the dog walk on a leash?

Is the dog crate trained?

Have you noticed any instances of food or resource guarding? If so, please describe in detail.

Please describe the dog's personality, including how they interact with children, dogs, and cats if known.

Please list what food the dog is current eating, as well as favorite treats and chews.

Where does the dog currently sleep?

Please describe any behavioral issues and past incidents. Provide as much detail as possible.

Why are you surrendering the dog at this time?

Do you have ownership of this dog, and the right to surrender or transfer it to Heartland Cavalier Connection Inc?

Yes

No

I affirm that all information provided is accurate to the best of knowledge.

I agree to transfer full ownership and rights to rehome and provide medical care and training to the dog described.

Signature

Signature field is empty.

Date

Month

Day

Year