Canine Surrender Profile
Once you have completed the pet's personality profile, you will receive the link to book your appointment for an owner surrender at the Idaho Humane Society.
Dog and Household Information
Please select one of the following. I am interested in surrending my pet due to the following:
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Please Select
I am no longer in a position to keep my pet
My pet is ill and needs medical care
My pet is a danger to myself or other humans
Owner's Name:
*
Owner's City and State where residing:
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Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
What is your dog's name?
*
What is your dog's gender?
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Male
Female
How old is your dog?
*
What is the breed of your dog?
*
Is your dog spayed or neutered?
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Yes
No
Don't know
Where did you get this dog from?
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This shelter (Idaho Humane Society)
Friend/Relative
Newspaper/Website
Found/Stray
Breeder
Pet Store
Other shelter/rescue
Other (please describe)
If from other shelter/rescue, please provide name:
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How long have you owned this dog?
*
Please provide more information with why you surrending your dog?
*
If our staff can provide resources or assistance to help you, would you consider keeping your dog?
*
Yes
No
If IHS determines that your pet is not a candidate for adoption through our shelter, would you like to be notified for pickup?
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YES: all pets must be reclaimed within 48 hours of notification, otherwise, it may be deemed an owner request euthanasia.
NO: I do not want to be contacted if my pet is not a candidate for adoption, and it may be deemed an owner request euthanasia.
If the difficult decision of euthanasia arises for my pet, please notify me to arrange private cremation. (Community cremations are complimentary, but ashes can only be returned with a private cremation).
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Yes
No
Typical Behavior
Please describe your dog's usual behavior
Including yourself, how many people of the following ages live in your house? Please list the ages of MEN inside the home:
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Please list the ages of WOMEN inside the home:
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Please list the ages of children that are BOYS inside the home:
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Please list the ages children that are GIRLS inside the home:
*
What other animals did your dog live with?
*
No other animals in the household
Dogs
Cats
Chickens/Poultry
Rabbits/Small Animals
Domestic Birds
Horses
Livestock
Other (please describe)
How does the dog interact with these animals?
*
How does your dog usually behave toward MEN your dog KNOWS:
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Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward WOMEN your dog KNOWS
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward CHILDREN your dog KNOWS
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward UNFAMILIAR MEN
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward UNFAMILIAR WOMEN
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward UNFAMILIAR CHILDREN
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward DOGS your dog KNOWS
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward CATS your dog KNOWS
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward OTHER ANIMALS your dog KNOWS
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward UNFAMILIAR CATS
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward UNFAMILIAR DOGS
*
Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually behave toward UNFAMILIAR OTHER ANIMALS
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Never encounter
Friendly
Afraid
Shows teeth/growls
Snaps
Bites
Other (please describe)
How does your dog usually react when an unfamiliar person approaches or enters the yard or house?
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Friendly
Afraid
Barks
Shows teeth/growls
Snaps
Bites
Other (please describe)
Does your dog usually have "accidents" in the house?
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No
Yes, please specify how often:
Would you describe these accidents as:
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Marking
Not fully housetrained
Behavioral (fear or excitement)
Other (please describe)
Where do you leave your dog when it is home alone?
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Inside the house (runs free)
Inside the house (in crate)
Inside the house (confined to 1-2 rooms)
Inside the house with access to yard via dog door
Outside the house (runs free in the neighborhood)
Outside the house (runs free in the yard)
Outside the house (in kennel)
Outside the house (tied)
Other (please describe)
Describe your yard (check all that apply)
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Fully fenced, 6+ foot fence
Fully fenced, 6 foot fence
Fully fenced, 4 foot fence
Partially fenced
Unfenced
Electric fence
Chain link
Wood
Vinyl
Iron
Other (please describe)
How long is your dog left alone, without people, during each day?
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Never
1-3 hours
4-8 hours
9-12 hours
Over 12 hours
Does your dog show signs of stress when left home alone? (for example: panting, drooling, destructive behavior, attempting to escape, vocalizing). If yes, please describe the behavior. ”
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No
Yes
Please describe the stress-behavior your pet exhibits when left alone:
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Where does your dog usually sleep overnight?
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Crate
Floor
Dog bed
Couch
Owner's bed
Outdoors (loose in yard)
Outdoors (kennel)
Other (please describe)
Tell us about your dog's "bad habits"
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Jumping Up
Mouthy
Plays roughly
Excessive barking
Digs holes
Destructive
Chases cars/motorcycles
Chases cats/small animals
Chases livestock
Chases bicycles
Jumps fences (please specify fence height)
Barks at things when on leash
Grabs food/items off counters/tables
Chases people
Urine marking
Runs away
Barks at things through fence
Escapes (please specify how often)
Other (please describe)
Please specify fence height that your dog jumps:
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Please specify details of how often your dog escapes?
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Is your dog allowed on furniture?
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Yes
No
What commands does your dog know?
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Sit
Down
Stay
Come
Heel
Shake
No commands known
Other (please describe)
Has your dog attended a formal obedience training class?
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No
Yes (please provide trainer's name)
Is your dog scared of anything? (i.e. fireworks, thunder, certain objects)
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No
Yes (please describe their reaction)
Does your dog have problems riding in the car?
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Don't know
No
Yes (please describe)
Describe how you provide physical exercise for your dog (please check all that apply)
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Play fetch
Walk on leash
Walk off leash
Take to dog parks
Doggy daycare
Run together
Play tug
Take swimming
Leave in backyard
Wrestle
Hunting
Other (please describe)
How would you describe your dog's personality? (please check all that apply)
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Friendly
Affectionate
Loving
Playful
Quiet
Cuddly
Timid/Shy
Calm
Anxious
Active
Hyperactive
Protective
Independent
Confident
Submissive
Fearful
What is your favorite thing about your dog?
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Aggressive Dog
Please list any behavior that has ever happened.
Has your dog ever fought with another dog?
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Yes
No
Don't know
Has your dog ever injured another dog?
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Yes
No
Don't know
Has your dog ever attacked another domesticated animal species (cats or livestock, but not "small pets" like hamsters, guinea pigs, etc.) resulting in injury or death to another domesticated animal?
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Yes
No
Don't know
Has your dog ever inflicted a bite to a person that has broken skin?
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Yes
No
Don't know
Has your dog ever shown aggressive behaviors towards MEN?
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Shows teeth/growls
Snapped or lunged at
Bite (did not break skin)
Bite (broke skin)
None of these
Has your dog ever shown aggressive behaviors towards WOMEN?
*
Shows teeth/growls
Snapped or lunged at
Bite (did not break skin)
Bite (broke skin)
None of these
Has your dog ever shown aggressive behaviors towards CHILDREN?
*
Shows teeth/growls
Snapped or lunged at
Bite (did not break skin)
Bite (broke skin)
None of these
Has your dog ever shown aggressive behaviors towards VETERINARIANS or GROOMERS?
*
Shows teeth/growls
Snapped or lunged at
Bite (did not break skin)
Bite (broke skin)
None of these
Has your dog ever shown aggressive behaviors towards other DOGS?
*
Shows teeth/growls
Snapped or lunged at
Bite (did not break skin)
Bite (broke skin)
None of these
Has your dog ever shown aggressive behaviors towards OTHER DOMESTICATED ANIMAL SPECIES (cat, livestock, etc.)?
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Shows teeth/growls
Snapped or lunged at
Bite (did not break skin)
Bite (broke skin)
None of these
Please explain the circumstances of the snap or bite. If you checked more than one bite in the answers above, please explain the circumstances of every snap or bite.
*
Was the aggressive behavior over food?
*
Men
Women
Children
Dogs
Not Applicable
Was it over bones, rawhides, or chews?
*
Men
Women
Children
Dogs
Not Applicable
Was it over toys?
*
Men
Women
Children
Dogs
Not Applicable
Was it over stolen objects?
*
Men
Women
Children
Dogs
Not Applicable
While breaking up a dog fight?
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Men
Women
Children
Dogs
Not Applicable
When the dog was in severe pain?
*
Men
Women
Children
Dogs
Not Applicable
Was it when the dog was disturbed while sleeping or resting?
*
Men
Women
Children
Dogs
Not Applicable
Was it when an adult or child handled the dog (brushing, handling feet, bathing, teeth brushing, ear cleaning, etc.)?
*
Men
Women
Children
Dogs
Not Applicable
Was it when an adult or child entered the house or yard?
*
Men
Women
Children
Dogs
Not Applicable
Was it when an adult or child approached and reached toward the dog?
*
Men
Women
Children
Dogs
Not Applicable
Medical History
Did your dog receive regular veterinary care?
*
Yes
No
Please list the contact info (name/phone) for your vet so we may request veterinary records (if needed):
*
Does your dog have any past or present medical conditions, medication, or special dietary requirements?
*
No
Yes (please describe)
Please feel free to tell us any additional helpful information about your dog:
Please feel free to upload a photo of your pet (optional)
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