Dog Surrender Request Form
We typically do not accept surrenders because we are a small shelter mostly run by volunteers. If you would like to surrender a dog, you can reach out to Pickaway County Dog Shelter at 740-474-3741. If we are accepting surrenders, a staff member may reach out to see how and when we may be able to help you. Please note that this is a request to surrender a dog. If you have multiple adult animals in the household that you need to surrender, please complete one form per animal. This is not necessary for litters of puppies. This surrender form is for PICKAWAY COUNTY RESIDENTS ONLY.
Are you a Pickaway County, Ohio resident?
*
Yes
No
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Are you willing to pay $100 (per adult) or $20 (per puppy under 12 months of age) surrender fee?
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Yes
No
Unable to pay a surrender fee
Are you able to provide proof of full vaccination status?
*
Yes
No and I understand my current surrender cost will be an additional $20/dog.
Is this dog spayed/neutered?
*
Yes and I will provide proof of spay/neuter.
No.
Unknown.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email (primary way we will contact you)
*
example@example.com
I need to surrender
(enter number)
*
dog(s).
Reason For Surrender:
*
If this is a litter of puppies, do you want to surrender their Mom?
Yes
No
Name of Dog
*
How long have you owned the dog?
*
This Dog is:
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Male
Female
Unknown
Litter of Puppies
Age:
*
Breed/Description:
*
Weight:
*
0-25lbs
25-50lbs
Over 50 lbs
Where did you get the dog?
*
Shelter/Rescue
Found Stray
Pet Store
Giveaway
Breeder
Other
If from another shelter or rescue, which shelter/rescue?
Has this dog been seen by a Veterinarian?
Yes
No
What vet do you use for the dog?
Does the animal have any past or current medical concerns or conditions?
*
Yes
No
If YES, please describe the animal's medical concerns and/or conditions:
Is the dog good with (select all that apply):
*
Men
Women
Children
Cats
Dogs
Other
Is this dog NOT good with (select all that apply):
*
Men
Women
Cats
Dogs
Children
Good with Everything
Has this dog been around children?
*
Always
Sometimes
Never
Does this dog have separation anxiety?
*
Yes
No
Unknown
Has this dog ever bitten someone?
*
Yes
No
Unknown
If YES, please explain:
Where is the dog housed during the day?(example: crate, outside)
Where is the dog housed at night?
Is this dog housebroken?
Yes
No
Unknown
Is this dog leash-trained?
Yes
No
Unknown
Attach a photo of the dog that you would like to surrender:
*
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Please provide any additional information about the dog below.
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We only accept surrenders from Pickaway County, Ohio residents. Please contact the humane society or animal shelter in your county of residence for assistance.
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