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Owner Surrender Form

This is our initial surrender questionnaire. If your animal is one we could help home, we will send you a longer version to complete.

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Where did you hear about us? *

Phone *

Email *

Home Address *

Address Line 1

City

State

Zip Code

How long have you owned this pet? *

Who / Where did this pet come from? *

What is the reason for surrendering? *

Is there a deadline? *

Animal Info

Type: *

Coloring: *

Weight *

Breed: *

Sex *

Male
Female

Name: *

Birth Date / Age? *

Is this animal an indoor or outdoor pet? *

Why? *

Behaviors

What negative behaviors does this pet have? *

Digger
Jumper
Howler
Barker
Chewer
Escape artist
High prey drive
Other
None

Other negative behaviors? *

What positive behaviors? *

What are this pets likes / dislikes? *

Interactions

Is this animal good with strangers? *

Children? *

Women? *

Men? *

Is this animal good with other animals, and if so which types? *

Good with other dogs? *

Male dogs? *

Little dogs? *

Female dogs? *

Big dogs? *

Care

How much, how often, and what type of exercise does this animal get currently? *

How much and what type of exercise does this animal need? *

Where does the animal sleep? *

Where is the animal kept? *

Where is this animal kept when you aren’t home? *

House trained? *

Has the animal been to a vet? *

Crate trained? *

If so, which vet(s), and when was last visit? *

Is this pet fixed and vaxxed and if so, how long ago and what clinic/ vet? *

Does this animal have any medical needs? *

How long does this animal spend alone daily, or at one time if not alone daily? *

Does this animal have separation anxiety or destroy things? *

File Upload *

Click or drag files to this area to upload. You can upload up to 10 files.

Attach dog photos, parent photos, and any embarks.