Animal Surrender_Intake Request

Camp Chaos Big Paw Rescue Inc.

We understand that rehoming your dog is a very difficult decision and will do all we can to make it easier for you. Fill out this form to the best of your ability. Your answers will help us get to know the animal in question and will ensure that if we are able to place the dog in a foster home or a new home, that the home is adequate for the needs of the dog. Above all, please be honest, failure to be honest with us can cause multiple issues, from the dog being placed in an incorrect foster with our program to legal issues for you and our rescue. We will do all we can to help but cannot make any promises that information entered on this form will result in the dog being taken into our program.

Your Name*

Your Email*

example@example.com

Your Phone*

Street Address*

Street Address Line 2

City*

State / Province*

Zip Code*

Animal's Name*

Breed*

Color(s)*

Under 8 weeks

Months/Years*

Approximate Weight*

Socialization*

Has your dog been spayed/neutered?**

YesNoUnsure

Has your dog had any vaccinations, heartworm testing or any other vetting? If so, please describe below in other*

VaccinationsHeartworm testingPreventative MedicationsOther

Is your dog Obedience trained?*

YesNoSomewhat (knows basics)Other

Has your dog been around children? If yes, please provide ages.*

Has your dog been around other dogs? If yes, please provide breed, age, gender*

Has your dog been around other animals? If yes, please provide species and temperament/reaction.*

Has your dog ever bitten anyone?*

Please tell us the reason for surrendering the dog

When we take a dog. we provide all necessary care. Whether it takes weeks or months to find it a home, we keep the dog with us and incur the cost of its care and vetting. We fundraise and pay for our rescue work out of our own pockets. It is partially funded by our adoption fees, but this typically does not cover all expenses during the year. Amount of donation offered to help us cover the cost of vetting/caring for this dog?

Amount of donation offered to help us cover the cost of vetting/caring for this dog?*

If non-monetary donation, please list what items your dog will come with?*

Please take 3 good quality, well-lit photographs of the animal and email them to us at rescue@campchaosrescue.org with your name and the animal's name in the subject of the email. If you have any videos of the dog. please send those as well, or send us the links to them. Please include any recent vet records you have on the dog.

By clicking the submit button below, your answers to this form attest that the information you have given is accurate and true. You also agree that, upon being accepted into Camp Chaos Big Paw Rescue's program, you will voluntarily relinquish all claims and ownership of said dog to the organization known as Camp Chaos Big Paw Rescue and members thereof. You understand that you cannot reclaim the dog once the dog is in possession of Camp Chaos Big Paw Rescue and understand that the animal will be spayed or neutered, if needed, in accordance with Florida state law. You agree to give up the dog's AKC registration papers (if available) and all medical records available. Neither Camp Chaos Big Paw Rescue nor members thereof shall be held responsible for the actions of the adoptive or foster family and/or dog. You furthermore certify that this dog is not vicious and has never shown signs of aggression towards human beings, unless otherwise noted above, and certify that this dog has never bitten anyone, unless otherwise noted above.

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