Stray Surrender Form

Stray Surrender Form

FosterDocHouston Dog Rescue
Your Info
Name*

First NameLast Name
Phone Number*
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dog & Household Info
Dog's Name:*
If unnamed, enter N/A
Breed:*
Sex:*

MaleFemaleNeutered MaleSpayed Female
Estimated Age:*
In months or years
How long have you had this pet?*
How and where was this pet found?*
Has this pet been scanned for a microchip?*

Yes, this pet does NOT have a microchipYes, this pet does have a microchipNo, this pet has not been scanned
What efforts have been made to locate this pet's possible owners?*

Posted on social mediaPut up flyersAsked neighborsNone of the aboveOther
How long are you able to hold onto this pet for?*
Are you able foster this pet (with care covered by us)?*

YesNo
If yes, for how long?

2 to 7 days1 to 2 weeks2 to 3 weeks1 to 2 monthsUntil adoptionUntil there is a physical opening at our shelter (could be anywhere from a week to a month)
Behavior
What other animals has this pet been around while in your care, if any?*

NoneDog(s)Cat(s)Other
If this pet has been in contact with other animals while in your care, what was his/her reaction?*

Friendly/ExcitedTimid/Shy/SubmissiveDefensive/UnsureAgressiveHas not been around other animalsOther
What is this pet's reaction to you and other familiar people?*

Friendly/ExcitedTimid/Shy/SubmissiveDefensive/UnsureAgressiveOther
What is this pet's reaction to new/unfamiliar people?*

Friendly/ExcitedTimid/Shy/SubmissiveDefensive/UnsureAgressiveHas not been around anyone other than myself and/or familyOther
Is this pet potty/house trained?*

YesNoSomewhatUnknownOther
How many hours per day is this pet left alone on average?*

Never1-3 hours4-8 hours9-12 hoursOver 12 hours
When left alone, where is this pet kept?*

OutdoorsFree Roam In HomeConfined To A RoomCratedOther
How does this pet do in a crate/kennel?*
Has this pet shown fearfulness of anything, such as thunder, loud noises, men, etc?*

YesNo
If yes, please explain:*
If no, enter N/A
Where does this pet sleep overnight?*

CrateDog bedFloorCouchFree in the houseYour bedOutsideOther
Please list any bad habits this pet has displayed while in your care, if any:*
If none, enter N/A
What commands does this pet know?*

NoneSitDownStayComeLeave itPlaceHeelOther
To your knowledge, how does this pet behave on a leash?*

Walks wellPullsPanics/thrashesCowers/does not want to moveReactive to other dogsReactive to peopleOther
To your knowledge, does this pet have any problems riding in a car (anxiety, restless, tries to escape)?*

YesNoOther
If yes, please explain:*
If no, enter N/A
Has this pet escaped from/attempted to escape from your property while in your care?*

YesNo
If yes, please explain:*
If no, enter N/A
To your knowledge, has this pet ever attacked or bitten a person?*

YesNo
If yes, please explain:*
If no, enter N/A
To your knowledge, has this pet ever attacked or bitten another dog?*

YesNo
If yes, please explain:*
If no, enter N/A
To your knowledge, has this pet ever attacked or bitten any other type of animal?*

YesNo
If yes, please explain:*
If no, enter N/A
Medical
Please list the contact info of any/all veterinarians that have seen this pet, if any:*
If this pet has not seen a vet, enter N/A
If this pet has seen a vet while in your care, what services were done? (deworming, vaccinations, bloodwork, etc) *
If this pet has not seen a vet, enter N/A
Has this pet been tested for heartworms?*

Yes, this pet is heartworm NEGATIVEYes, this pet is heartworm POSITIVENo, this pet has not been tested
Has this pet been given heartworm preventative since in your care?*

YesNo
If yes, what date was it given and what brand?*
If no, enter N/A
Has this pet had to be muzzled at the vet?*

YesNoHas not seen a vet
If this pet needs additional standard veterinary care (such as vaccinations, spay/neuter), would you be willing to sponsor or make a donation?
Other
Please feel free to tell us any other additional information about this pet:
Please attach at least 1 full body picture of the pet:*

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Please attach at least 1 head shot picture of the pet:*

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Please upload any medical records you have for the pet:

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By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval, and that untruthful answers or failure to comply with the requirements of this application can result in the denial of any animal submitted as an intake request by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release and to hold harmless FosterDocHouston Dog Rescue and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the surrendered dog.

I accept full responsibility for the dog(s) actions at all times, and release FosterDocHouston Dog Rescue from any liabilities or damages that may be incurred because of surrendering such dog(s).

I agree to have FosterDocHouston Dog Rescue complete reference call checks and conduct a home visit inspection and/or home facetime to be able to approve my surrender application.
Sign Here To Agree:*

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Stray Surrender Form

Your Info

Dog & Household Info

Behavior

Medical

Other