Puppy Surrender Application
NOTE: Completing this form does not guarantee we will be able to accept these puppies into our agency. Please only fill this form out for puppies UNDER 6 months of age.
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
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Please Select
Geauga
Lake
Ashtabula
Cuyahoga
Portage
Trumbull
Mahoning
Summit
Other
Phone Number
*
Please enter a valid phone number.
Email- If you do not have email, write in: intake@rescuevillage.org
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example@example.com
How many puppies do you have to surrender?
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If you know the exact age, please specify here:
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Month
-
Day
Year
Date
Age?
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Breed?
*
If you are able, please upload a picture of the puppy or puppies.
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How many males and how many females are there in the litter?
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Do you own the mother?
*
Please Select
Yes
No
What is the mother's dog breed?
This question is not mandatory, skip if you do not have the mother.
Do you own the father?
*
Please Select
Yes
No
What is the father dog's breed?
This question is not mandatory, skip if you do not have the father.
Was this litter accidental or planned?
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Accidental
Planned
Not applicable, I don't have the parents
Why are you needing to surrender this puppy (or puppies)?
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Does the puppy/puppies have a name/names?
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Was this a puppy adopted from Rescue Village?
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Please Select
Yes
No
Where did you originally get the puppy?
Do the puppies appear healthy?
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Please Select
Yes
No
If you marked no above, what illness/injury are you observing?
Where are the puppies currently staying?
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As part of the surrender process for puppies, we will ask that you have the parents spayed/neutered if you own one or both of them to prevent further homeless puppies from entering the shelter. We do have resources for low cost spay/neuter
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I understand
Not applicable, I do not own the parents
Would you be interested in doing Foster to Surrender with these puppies? This means we have you bring the puppies to our shelter for their first vaccines, then you take them back and we will schedule them back in to stay in 2-3 weeks. We also can provide supplies during this time such as food, toys, etc.
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Yes, I would like to learn more about this option.
No, this will not work for me.
I understand that I must have an appointment to surrender this puppy/these puppies and that the shelter does not accept walk-in surrenders.
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I understand
Rescue Village requires a $50 fee per litter to help offset some of the cost of caring for this puppy/these puppies during their time with us, including medical care. In certain circumstances, we can reduce or waive this fee but it must be discussed with the Intake & Rescue Manager prior to your surrender appointment.
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I understand and can provide the full fee.
I understand an am asking for a reduced or waived fee.
I agree to check my email, including my spam/junk folder, for important communications regarding this surrender form.
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I understand and will check me email AND my spam/junk folder
I do not have email and will require a phone call.
By signing below, I understand that Rescue Village has the right to deny my surrender form for any reason. I also understand that if my surrender form is accepted, there may be a lengthy wait because Rescue Village does NOT euthanize animals for time or space reasons and can only schedule in puppies as cage space allows.
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