DOG SURRENDER FORM

Dog Surrender Form

Dogs Accepted By Appointment ONLY
Please keep in mind that the more accurate information we have about your dog, the better able we are to place them in an appropriate home.

There is a surrender fee of $50 if your dog is spayed/neutered, current on vaccinations & you provide documentation. The surrender fee is $70-$80 if your dog is not current or if you do not have documentation. These fees contribute to the care of your dog and help keep the shelter open.
Owner Information
Name*

First NameLast Name
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Driver's License #*
Email
example@example.com
Dog Information
Dog's Name
Age*
Sex*
Breed*
Color(s)
Is your dog spayed/neutered?*
How long have you had your dog?*
Where did you acquire your dog?*
Is your dog micro-chipped?
If yes. chip number and/or company:
Why are you surrendering your dog?*
DOG'S HABITS AND BEHAVIORS
How many hours per day is your dog indoors?
How many hours per day is your dog outdoors?
When home alone, where is your dog kept?
Is your dog crate trained?
Has your dog lived with men?*
Type a question*
Describe your dog's behavior with MEN: (select all that apply)*

FriendlyPlayfulAffectionateShy/TimidFearfulAggressiveOther
Has your dog lived with women? *
If yes, what ages?*
Describe your dog's behavior with WOMEN: (select all that apply)*

FriendlyPlayfulAffectionateShy/TimidFearfulAggressiveOther
Has your dog lived with children?*
If yes, what ages?*
Describe your dog's behavior with CHILDREN: (select all that apply)*

FriendlyPlayfulAffectionateShy/TimidFearfulAggressiveOther
What other animals has your dog lived with?*

DogsCatsBirdsReptilesOther
Describe your dog's behavior with DOGS by selecting all that apply*

Wags TailPlaysAvoids/Does NothingBarksGrowlsSnapsOther
Describe your dog's behavior with CATS by selecting all that apply*

Wags TailPlaysAvoids/Does NothingBarksGrowlsSnapsOther
Please select the traits that best describe your dog

FriendlyUnfriendlyAffectionateShy/TimidRoughGentleQuietLoudSmartStubbornEnergeticLazy
Please select your dog's "bad habits"*

Jumps on PeopleDigs HolesBarks ExcessivelyFights With Other PetsDestroys Household ItemsHas Accidents InsideChases Cats/Squirrels/Rabbits, etcEscapes YardOther
Does your dog show protective behaviors with any of the following?*

FoodTreatsToysOther
What toys does your dog like?

BallsKongsFrisbeesSqueaky ToysStuffed ToysRopesOther
What are your dog's favorite activities?

FetchTugChaseWrestlingWalksRunsOther
What commands does your dog know?

SitStayComeHeelDownShake/Give PawOther
Has your dog had professional training?
If yes, when and where?
If your dog has accidents inside, how long can he/she generally hold it?*
How frequent are the accidents?*

DailyWeeklyMonthlyOther
Where does your dog sleep most often?
Is your dog allowed on furniture?
Does your dog enjoy car rides?
Has your dog injured or bitten anyone?*
If yes, please explain:
Feeding and Veterinary Care
What brand of food does your dog eat?
How much per feeding?
How many times per day does your dog eat?
Who is your dog's veterinarian?*
Date of your dog's most recent vet visit:*

MonthDayYear
Date
Does your dog require a muzzle for vet appointments?
Does your dog have any past or current medical conditions?*
If Yes, what are they?*
Is your dog currently on any medication(s) or a special diet?
If Yes. what?
I attest that I am the legal owner of the dog described above, or duly authorized agent thereof. I hereby relinquish and transfer ownership of this dog to The Humane Society of Ottawa County (HSOC).
Owner Signature*

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Date*

MonthDayYear
Date
Fee Paid
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Dog Surrender Form

Owner Information

Dog Information

DOG'S HABITS AND BEHAVIORS

Feeding and Veterinary Care