Surrender Application How many pugs are you surrendering?*OneMultiple (Please complete a form for each Pug)Pug's Name*Is this a prior PRoNE pug?*YesNoAge*Neutered or spayed?*YesNoGender*Color*Where did you get this pug?*BreederFriendCraigslist or onlinePet storeShelter or RescueYour Name*Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Are you the legal owner of the Pug?*YesNoAre you the first owner? If not, list previous owner.*Do you have a contract with the breeder for return of the dog?*YesNoHow long have you had this pug?*Is this a purebred Pug? Please note, we will consider pug mixes on a case by case basis.*YesNoTell us about your pug. (check all that apply) Fine with other dogs Fine with cats Fine with young children Best with older children No kids for this pug, please! Crate trained Housebroken Working on house breaking, needs some help Friendly and easy going Walks well on the leash Needs structure & routine High energy Other If you chose other above, please tell us why here.Reasons for surrendering (check all that apply) New baby Allergies (pug) Not enough time Moving, cannot take dog Found as stray Behavior problems Health Issues (Owner) Health issues (Pug) Cannot afford care New home Other If you chose other above, please tell us why here.Please select health issues (check all that apply) Eye issues Ear issues Breathing issues Heartworm positive Lyme positive Diabetic Seizures/epilepsy Arthritis/joint/mobility Paralysis Mange or skin infection Blind Deaf Allergy No health issues Please select any behavior issues (check all that apply) Has shown aggression towards dogs Has shown aggression towards cats/small animals Has shown aggression towards children Has shown aggression towards adults Destructive / separation anxiety Has shown resource guarding (guards food/toys/people Hyperactive Trouble house training / marker No behavior issues Please explain behavior problems (be specific).*Is your pug on any medication?*YesNoPlease list medications.Current Vet's Name*Vet's Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Vet's Phone*Date of Last Shots* Date Format: MM slash DD slash YYYY Has your pug been vaccinated against rabies within last 3 years?*YesNoHas your pug had distemper vaccine within last 3 years?*YesNoHas pug been tested for heartworm and lyme within the last year?*YesNoHeartworm & Lyme results* HW negative, taking monthly preventative HW negative, no monthly preventative HW positive, treatment needed Lyme positive, no treatment Lyme positive, being treated No testing for heartworm/lyme How did you hear about PRoNE?PRoNE WebsiteSearch EngineFacebookFriendVetSurrender time frame? Your honest answers, vetting needs and available foster homes determine how quicky we can take in any pug/pugs.*My situation is an emergency.1 to 2 weeks2 to 3 weeks3 to 4 weeks4+ weeksUpload a picture of your PugPlease tell us anything else that you think we should know about this Pug. This iframe contains the logic required to handle Ajax powered Gravity Forms.
