Dog Surrender Request Form

Dog Surrender Request Form

This is a request form for those looking to rehome their dog through KC PAWS. Please note that we are a small non profit rescue and we can not always take on all request depending on space availability and resources. Please also note that we often do have a waiting list for intake, and we do prioritize dogs in critical situations. We ask that those wanting to surrender their pet be willing to allow us the time to help find the appropriate placement for your pet.
Name:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Date:*

MonthDayYear
Date
Animal's Name:*
Age*
Breed*
Where did you get your pet?*
Is your dog current on vaccinations?*

YesNo
If your pet is not current on vaccinations, would you be willing to get your pet vaccinated to help us have a better ability to help your pet?
Please upload your pets current vaccination records if applicable:

Browse Files

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If you do not have your pets vaccinations, please list the name and number of the vet clinic that has your pets vaccinations on file?
Is your dog spayed or neutered?*

YesNo
Upload a picture of your dog.*

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Check the corresponding boxes to inform KC PAWS Canine Behavior Specialist as to whether or not your pet has any behavioral concerns worth noting or working on with a professional trainer while in shelter or in foster. Any items marked "Unknown" will be evaluated. Please use the back of this sheet to elaborate on any items which you think require additional information
Is your dog an escape artist?*

YesNoUnknown
Does your dog struggle to be confined (in a crate)?*

YesNoUnknown
How many hours a day is your pet home alone?*
Is your dog reactive to seeing people when on leash?*

YesNoUnknown
Is your dog reactive to seeing dogs when on leash?*

YesNoUnknown
Is your dog destructive in the home?*

YesNoUnknown
Does your dog get anxious in the car/carsick?*

YesNoUnknown
Is your dog potty trained?*

YesNoUnknown
Has your dog received basic obedience training?*

YesNoSome
Is your dog protective of their food?*

YesNoUnknown
Is your dog protective of their toys?*

YesNoUnknown
Is your dog protective of their bed/space?*

YesNoUnknown
Is your dog protective of their furry siblings (if any)?*

YesNoUnknown
Is your dog protective of their handler?*

YesNoUnknown
Is your dog okay with small children (baby-todder age)?*

YesNoUnknown
Is your dog okay with children 5-10?*

YesNoUnknown
Has your dog ever lived with other dogs?*

YesNoUnknown
Has your dog ever lived with or played with dogs smaller than them?*

YesNoUnknown
Has your dog lived with or played with dogs larger than them?*

YesNoUnknown
Has your dog ever injured a dog?*

Yes (provide detail)NoUnknown
Has your dog ever lived with cats?*

YesNoUnknown
Has your dog ever injured a cat?*

YesNoUnknown
Has your dog been fearful of children?*

YesNoUnknown
Has your dog been fearful of men?*

YesNoUknown
Has your dog fearful of women?*

YesNoUknown
Has your dog enjoyed playing with toys?*

YesNoUnknown
Has your dog enjoyed treats?*

YesNoUnknown
Has your dog ever injured a person?*

Yes (explain)NoUnknown
If your dog has ever injured or bit a person, please describe the incident in as much detail as possible. *
Does your dog have any known allergies, health conditions, or injuries?*
Reason for Surrender*
If resources and/or training can be provided to you through KC PAWS, would you be willing to keep your pet?*
If you are no longer willing to keep your pet, would you be willing to keep your pet as a foster through our program if KC PAWS can post your pet for adoption and help with the rehoming process?*
Are there any additional notes you would like to provide about your pet?
Our mission is to save the lives of homeless pets by changing the way our community views animal sheltering and shelter pets . We provide a new type of sheltering experience which allows the dogs in our program to interact and play with other dogs in our community on a daily basis. Through education and a change to the way animal shelters and homeless pets are viewed in the eye of the public, our mission is to eradicate the perception that shelter dogs are somehow different than other dogs living in our community and to encourage the public to visit their local shelters and adopt rather than shop for their next family member.

At Kansas City Protective Animal Welfare Society, we are a non profit organization that specialize in cases of animal cruelty and neglect. We work with other private rescue groups to save as many dogs as possible through our match based adoption process.
By signing this form, I acknowledge that I am the current legal owner of this animal and that I am requesting relinquishment of all rights to this animal and transferring those rights to KC Protective Animal Welfare Society (KC PAWS) who will assume full responsibility for the animal, should my request be approved, and my pet surrendered to KC PAWS:*

I hereby give KC Protective Animal Welfare Society permission to request all medical history and medical records from my Veterinarian for the animal I am relinquishing.
Signature*

Clear
We recieve a large number of request to take in dogs daily, please understand that our goal is to help as many dogs as possible, but with only a certain amount of kennel space, and limited foster homes, we have to make intake desisions based off of available resourses depending on space, and each dogs individual needs. If we can not intake your pet, we will do everything we can to reach out to our rescue partners network and provide other possible resources, please note that networking rescue placement takes time to coordinate, our team will reach out to you as soon as possible. Please be patient as we do our best to help while also caring for the dogs in our care daily.
Please mark read/understood:*

I understand
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