First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Alternate email

Alternate Phone

Best time to reach you?

Dog Name*

Sex*

Spayed/Neutered*

Date of Birth/Age (estimate if unsure)*

Please provide approximate dog weight*

Is your shar pei a purebred or mix?*

Is the dog housebroken?*

If partly please describe when accidents occur:

Has your dog ever bitten anyone?*

If yes, please describe:

Are there any behavior problems? *

If yes, please describe:

Does the dog get along with other dogs?*

Does the dog get along with Cats? *

Does the dog get along with Other animals (birds, rodents, etc)?

Is the dog ok around children?*

Are there children currently in the home?*

If yes, What are their ages?

Where did you originally get dog? Please provide name, address and telephone *

How long have you owned this dog? *

Why is the dog being given up?*

What is the name and phone of the veterinarian who last treated and vaccinated this dog?*

Is the dog current on vaccinations?*

If vaccinated, please list the date the dog's Rabies vaccine expires

Is your dog microchipped?*

Does the dog have any health problems? *

Donation – are you able to make a donation when surrendering this dog?*

Please be sure to email two photos of your dog to adopt@peipeople.com when you have finished submitting this form. We cannot consider the request complete until we have photos. Once we get completed request, we will assign the request to the Pei People state coordinator in your state for review. Please allow several days for a reply. Thank you for considering Pei People to take on the care of your dog.