SURRENDER REQUEST FORM
When you submit this form, we will contact you if and when we are able to intake your dog. By submitting this form, you agree we are allowed to forward any information to other rescues that we think may be able to help.
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
Location of the dog (city/state)
Type a question
Age of dog
Breed of dog
Weight of dog
How long have you owned the dog?
Where did the dog originally come from?
Is the dog spayed or neutered?
Too young (Under 6 months)
Is the dog up to date on vaccines from. Licensed veterinarian?
Has the dog been tested for heartworms?
Date of heartworm test (type n/a if no test has been done)
If tested, what were the results?
Has the dog been on heartworm prevention?
Is the dog microchipped?
Date of dogs last vet visit
Does the dog have any known medical problems?
Is your dog good with kids?
Is your dog potty trained?
Please check all that apply
Friendly with strangers
Leary of strangers
Good with other dogs
Good with cats
Why are you rehoming this dog?
Please upload a photo of your dog.
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Choose a file
Should be Empty: