WCAS Dog Surrender Questionnaire
In order for WCAS to determine the placement needs of your pet that you are looking to rehome, please be sure to answer the following questions truthfully and in detail.
General Information
Name of Legal Owner
First Name
Last Name
Is the legal owner a resident of Waushara County?
Yes
No
If the legal owner is NOT a resident of Waushara County, where do they live?
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your preferred contact method?
Phone Call
Text
Email
Dog & Household Information
What are the steps that you have already taken to try and rehome your dog? (Facebook rehoming groups, asked family and friends, etc.)
Dog's Name:
Sex of Dog:
Female
Male
Spayed Female
Neutered Male
Age or Estimated Birthday:
Breed:
Where did you get your dog? If you got your dog from another shelter or breeder, have you contacted them to see if they would like the dog back?
What specifically influenced the decision to surrender/rehome your dog?
If we could help you or provide you with resources, would you consider keeping your dog?
Yes
No
Maybe, I'd like to talk to someone more about it.
What household members has your dog lived with?
Adult Men
Adult Women
Elderly Women
Elderly Men
Teenagers
Children
Toddlers/Infants
Other
Would you recommend your dog going to a home with children? If yes, what ages would be appropriate?
What other animals has your dog lived with?
Male Dogs
Female Dogs
Cats
Small Mammals
Farm Animals/Livestock
Other
How does your dog behave around other dogs?
Is never around other dogs.
Shy/Timid
Does great with all dogs!
Good with some dogs, but not all. (Dog Selective)
Ignores or Indifferent
Reactive
Other
What vaccinations is your dog current on that you can provide documentation for?
Bordetella
Canine Distemper
Leptospirosis
Lyme Disease
Rabies
Unknown/No Vaccination History
What veterinary clinic do you take your dog to for medical care?
Does your dog have any previous or current medical conditions/diagnoses or health concerns?
Has your dog ever bitten a person or another animal?
Yes
No
If your dog has ever bitten a person or another animal, please describe the circumstances surrounding the incident.
What do you love most about your dog? What are some fun personality traits about them? Do they know any tricks?
Please upload a photo of your dog.
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Signature
Date
-
Month
-
Day
Year
Date
Thank you for filling out our dog surrender questionnaire!
Our shelter coordinator will be in touch with you within 48 to 72 hours. If you are experiencing an urgent situation and need immediate assistance, please reach out to WCAS at (920) 279-9795.
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