Owner Surrender Form

The name, address, and phone number of your current veterinarian (if you have one) and the date of your dog's latest vaccines.
 

About You

About your Dog


Gender of your Dog. *
Is your dog altered (spayed/neutered/fixed)? *
Is your dog microchipped? *
Does your dog have hotspots? * 
Does your dog have fleas? *
Does your dog have allergies? *
Are vet records available? (If not, please authorize your vet to share information with us) . *
 
Is your dog... (Check all that apply) *
Does your dog do any of the following? (Check all that apply) *
Has your dog been exposed to children? *
Has your dog ever been exposed to cats? *
Has your dog ever been exposed to livestock? *
Does your dog bark excessively? *
 
Is your dog possessive of any of the following? (Please check all that apply.) *
Has your dog ever bitten, or attempted to bite any of the following? (Please check all that apply.) *

Time Frame

Are you willing to continue to care for your dog while we look for a new home for him or her? *
 

Additional Information

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