Dog Surrender Form
Yolo County Animal Services
Date
-
Month
-
Day
Year
Date
Do we have your permission to post a rehoming animal bio with our partners?
*
Yes
NO
Owner's Name
*
First Name
Last Name
Owner's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Dog's Name:
Please upload a picture of your dog.
Browse Files
Drag and drop files here
Choose a file
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of
Dog's Breed:
Dog's Age:
Dog's Color:
Dog's Gender
Please Select
Male
Female
Is your dog spayed or neutered
Please Select
Yes
No
Is your dog current on vaccines
Please Select
Yes
No
Unknown
How long have you had the dog?
Where did you get the dog?
Reason for Surrender/Return
Please Select
Housing
Behavior
Medical Care
Other
If other please describe
If you are surrendering because of medical reasons please describe the dog's symptoms and provide your Veterinarian's contact information below:
Has your dog bitten a person?
Please Select
yes
no
If your dog has bitten please describe the bite. Did it break the skin? Did the victim require stitches? What were the circumstances behind the bite?
Has your dog shown any of the following negative behavior
Growling
Snarling
Lunging
Snapping
Fence Jumping
Other
If your dog has displayed any of the above negative behaviors please describe.
How would you describe your dog's behavior around childern?
Please Select
Friendly
Fearful
Aggressive
Never been with children
Where did you keep your dog
Primarily Outside (4 plus hours at a time)
Primarily Inside
Both Inside and Outside
Is your dog potty trained?
Please Select
yes
no
unknown
Is your dog crate-trained?
Please Select
yes
no
unknown
Does your dog allow people to take food and toys away from them?
Please Select
yes
no
When you have visitors to your house how does your dog behave? Please explain. (For example: We keep it away from visitors or It allows visitors to pet he/she etc.)
Have you tried to rehome this pet on your own
Please Select
yes
no
If yes, please describe what resources you used to rehome your dog i.e. Facebook, Craigslist, Nextdoor, family members, etc.
Has your dog been seen by a veterinarian?
Please Select
yes
no
If yes, please provide the vets contact information.
Has your dog lived with any of the following?
Dogs
Cats
Kids
Rabbits
Chickens
Livestock
Is there anything else you think we should know about your dog?
Signature
Submit
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