Surrender/intake form

Raise the Woof Nola Inc.

We understand that rehoming your dog is s 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 is 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 wth us can cause multiple issues, from the dog being placed in an incorrect foster with our program to legal issues with you and our rescue. we will do all that we can to help but cannot make any promises that information entered on this form will result in the dog taken in to our program.

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Name of animal*

breed*

Age*

color*

Approx weight*

yesnounsure

vaccinationsHeart worm testedpreventative medicationsOther

yesnosomewhat (knows basics)Other

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

Has your dog been around other dogs? if so what size, age, gender?*

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

Has your dog ever bitten anyone?*

Please tell us the reason for surrendering the dog*

When we take in a dog we provide all necessary care. Whether is 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 typacally does not cover all expenses during the dogs stay. Amount of donation offered to help us cover the cost of vetting and caring for this dog?

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

If not a monetary donation, please list what items your dog will come with.

Please take three good quality, well lit photographs of your dog and email them to us at raisethewoofnola@gmail.com with your name and the animals name in the subject line of the email. If you have or can take any vidoes of the dog please send those as well, or send us the links to them. Please include any recent vet records of 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 Raise The Woof Nola's rescue, you will voluntarily relinquish all claims and owernship of said dog to the organization known as Raise The Woof Nola rescue and members thereof. You understand that you cannot reclaim the dog once the dog is in possession of Raise The Woof Nola and understand that the animal will be spayed or neutered, if needed, in accordance with Louisiana state law. You agree to give up the dog's AKC registration papers (if available) and all medical records available. Neither Raise The Woof Nola 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.

Form

Animal surrender-Intake request