Puppy Surrender Application
Filling out an application does not guarantee that we will be able to accept the puppy/puppies into our shelter.
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
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Please enter a valid phone number.
Email- If you do not have email, write in: animalintake@rescuevillage.org
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example@example.com
How many puppies do you have to surrender?
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What is the reason you need to surrender the puppies/puppy? Please give as much detail as possible:
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If you know the exact age, please specify here:
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Month
-
Day
Year
Date
Age? (This form is only for puppies under 4 months of age. If submitting for a dog 5 months or older, please exit this form and complete the dog surrender form)
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Breed?
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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?
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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?
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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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Is there any additional information you would like us to know about the puppy/puppies?
*
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
I understand that Rescue Village has a service area and that if I am outside of that service area, I may be directed to other agencies for assistance depending on the situation, shelter capacity, waiting list length, etc.
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I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
I understand that Rescue Village requests an intake fee of $50 per cat to assist with cost of care.
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I understand and can pay the full fee.
I understand and am asking for a reduced fee.
I understand that I MUST have an intake appointment and that Rescue Village does not accept walk-in surrenders.
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I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
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.
I understand that Rescue Village is NOT an open admission shelter, meaning not every application is able to be accepted. I understand that Rescue Village is a limited admission, unlimited stay humane society and that my application can be denied for any reason.
I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
I understand that if my application is accepted, I may be placed onto a waiting list as Rescue Village never euthanizes for space. I understand that this waiting list may be lengthy.
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I understand
I am unable to wait and will seek out other options. I understand by selecting this option I will not be contacted.
Please understand that pets often behave differently in a shelter environment than they do at home or in their outdoor home due to stress and unfamiliar surroundings. For this reason, shelter surrender is not always the best or most appropriate option for every pet.
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I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
Rescue Village reserves the right to decline surrender requests at its discretion. We kindly ask that all interactions with our staff remain respectful. Any use of inappropriate behavior may result in refusal of services.
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I understand
I do not agree and will seek other options.
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 animals as species appropriate space allows.
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