Surrender Request Form

Surrender Request Form

Please fill out the form below and we will be in touch regarding your pup's intake status. The entire form must be completed to be considered.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Dog's Name
Dog's Age
Sex
Approximate Weight
Is the dog spayed or neutered?

YesNo
Is the dog UTD on vaccinations and preventative? Please list all they are UTD on.
Is the dog microchipped?

YesNo
Reason for Surrendering
How long have you owned the dog?
Is the dog:

House TrainedCrate TrainedKnows Basic Commands
Has the dog lived in the same house with: (Check all that apply)

Children under 10Children over 10Other dogsCatsMenWomenOther Animals
Any behaviour issues we should be aware of?
Has the dog ever bitten a human and/or animal? If so, please explain.
What brand of dog food are they currently eating?
Any health issues we need to be aware of?
How soon does the dog need to be placed?
Please upload a picture of the dog

Cancelof
By signing this, I attest that the information provided on this form is true and accurate to the best of my knowledge.
Date

MonthDayYear
Date
Signature

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