WCCR Surrender Request Form

Owner Surrender Request Form

*** PLEASE NOTE WE ARE ONLY ABLE TO ASSIST SMALL BREED DOGS (UNDER 25 POUNDS) ***
Windy City Canine Rescue

Email: windycityintake@gmail.com

Website: www.windycityrescue.com
Please complete one form for each animal you are looking to surrender.

As we do not have a building all dogs are housed in foster homes. In order to allow for a successful foster home placement until they are adopted we require as much infromation as possible. This information also allows our Adoption Coordinator to find an appropriate adoptive home for your dog.
Name:*
Address:*
City/Province:*
Postal Code:*
Contact Number:*
Email Address:*
example@example.com
Pet's Name / Nicknames:*
Sex: Male/Female Age:*
Breed:*
Where did you get your dog?*
More Details about Your Dog

PLEASE BE VERY SPECIFIC WITH YOUR ANSWERS SO THAT WE CAN PROVIDE THE BEST CARE FOR AND FIND THE BEST SUITABLE HOME.
Is your dog spayed or neutered? Yes/No*
How long have you owned your dog?*
Why are you surrendering your dog?*
Is your dog destructive when left alone? Yes/No*
If yes, please explain:
What commands does your dog know, if any?*
Is your dog house trained? Yes/No*
Is your dog crate trained? Yes/No*
Has your dog had previous training? Yes/No*
What veterinary does your dog go to?*
When was your dog last at the vet?*
When was your dog last vaccinated?*
Does your dog have any known health related issues? Yes/No *
If Yes please explain.
Does your dog currently live with children? Yes/No If yes, what ages?*
Please describe your dog's experience with children:*
Does your dog have any food aggression? Yes/No*
How Does Your Dog React?
To strangers?*
To visitors in the home?*
If you try to take away a toy or bone?*
If you take your dog's food while eating?*
If your dog is disturbed while sleeping?*
Any additional comments:*
Does your dog live with other dogs? Yes/No How many?*
If Yes, What are the age/sex/breeds ?
Does your dog get along with other dogs? Yes/No*
If yes, please explain your dogs experience with other dogs:
If no, please explain:
Does your dog get along with other type animals? Yes/No*
Does your dog live with cats? Yes/No*
If yes, please explain your dog's behavior with cats:
Does your dog have behavior issues? Yes/No*
If yes, please explain:
Does your dog have any fears? Yes/No*
If yes, please list all:
How does your dog react: When being seen by a veterinarian?*
When being groomed?*
To having his/her nails trimmed?*
Has your dog ever bitten anyone? Yes/No*
If yes, did it break skin? Yes/No
Was a bite report filed? Yes/No
Please explain the bite incident:
Please list a few things you like best about your dog:*
Why do you think your dog would be a good candidate for adoption?*
If Yes explain.
By signing this form, I state that I am the owner of the animal who is the subject of this Animal Surrender Request Form.
Signature*

Clear
Date*

MonthDayYear
Date
Please attach a photo of the dog you are looking to surrender*

Cancelof
Should be Empty:

More Details about Your Dog

How Does Your Dog React?