Owner Surrender Request

Dog Rehoming Request

We understand that rehoming your dog is a very difficult decision and will do all we can to make it easier for you. Fill out this form to the best of your ability. Your answers will help us get to know the animal in question, and will ensure that if we are able to place the dog in a foster home or a new home, that the home is adequate for the needs of the dog. Above all, please be honest - failure to be honest with us can cause multiple issues, from the dog being placed in an incorrect foster with our program to legal issues for you and our rescue. We will do all we can to help, but cannot make any promises that information entered on this form will result in the dog being taken into our program.

Name: *

Address: *

Email Address: *

Home phone number: *

Cell phone number:

Please give a brief description of the dog, including: name, breed, age, color, weight, etc. *

How long have you owned this dog? *

Is this dog current on vaccinations? (We will require proof prior to entering HMDDR's adoption program of any vaccines or medical history. Lack of current vaccination does not disqualify the dog from our program.) *

Yes I am not certain

How is your dog with people? *

Is your dog spayed or neutered? *

Yes No I’m not sure

How is your dog with other dogs? *

Has your dog ever bitten a person? *

No Yes

Does the dog have any health problems or is currently on medication? *

What things would you want a new owner to know about your dog? *

Is there anything else you want to tell us about your dog?

Please upload a photo or photos of your dog. *

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DISCLAIMER:

By typing your name into the signature blocks below, your answers to this form attests that the information you have given is accurate and true. You also agree that, upon being accepted into HMDDRs program, you will voluntarily relinquish all claims and ownership of said dog to the organization known as Hand Me Down Dog Rescue and members thereof. You understand that you cannot reclaim the dog once the dog is in possession of HMDDR and understand that the animal will be spayed or neutered, if needed, in accordance with California state law. You agree to give up the dog's AKC registration papers (if available) and any and all medical records available. Neither HMDDR nor members thereof shall be held responsible for the actions of the adoptive or foster family and/or dog. You furthermore certify that this dog is not vicious and has never shown signs of aggression towards human beings, unless otherwise noted above, and certify that this dog has never bitten anyone, unless otherwise noted above.

Signature (please use your finger or mouse to sign in the box) *

Clear

Date: *

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