PDF Form

Haven of Love Dog Rescue OWNER SURRENDER REQUEST FORM

If you are in need of surrendering your pet(s) please complete the form below. We also require any vet records be sent and a photo(s) be included. Please answer ALL questions honestly and to the best of your ability. PLEASE DO NOT HIDE ANY MEDICAL OR BEHAVIORAL ISSUES. Our goal is to place your pet(s) in the best possible home and this information is crucial in making a successful placement. Filling out this form is not a guarantee that we can accept your dog.
WE APPRECIATE YOUR HONEST ANSWERS TO THE FOLLOWING QUESTIONS:
Name of Dog
Breed Of Dog
Date

MonthDayYear
Date
Is the dog living with you ?
If you answered NO, please explain:
PET NAME:*
PET"S AGE*
SEX
Weight (in lbs)
Housebroken? (required)*
Crate trained?*
Leash trained?*
Barker?*
History of biting?*
Digger?*
Aggressive around food?*
Capable of doing tricks?*
Obedience trained?*
Sleeps in bed at night?*
Tell us anything else about the Dog's personality.*
Gets along with dogs?*
Get's on furniture?*
Gets along with kids?*
Gets along with cats?*
Chews household items?*
Rides well in cars?*
Vet's Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vet's Phone Number*
Date of last visit

MonthDayYear
Date
Reason for last visit
Has dog been treated for internal parasites?*
When did this treatment take place?
Is the animal on heartworm preventative?*
Date the heartworm preventative was last given

MonthDayYear
Date
Spayed/Neutered?*
Microchipped?
Microchip company?
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Are you the legal owner of this animal?*
If you answered NO above, please explain:
Where did you get your pet?*
How long have you had your pet?*
What is the reason for your surrender?*
Should be Empty:

Haven of Love Dog Rescue OWNER SURRENDER REQUEST FORM