Relinquishment Application

Japanese Chin's Name

Age

Sex

Male

Female

Color

Size

Health

Temperment

Has this dog ever behaved aggressively towards a person including biting?

Yes

If ‘Yes’, please explain

Has this dog behaved aggressively toward other dogs?

Yes

If ‘Yes’, please explain

Background - Tell us a little about your Chin's history. Where did you get your Chin?

Special Considerations

City

State

Zip

Your Name

Your E-Mail

Your Phone Number

Additional Information or Instructions for JCCARE