Surrender Form - Oregon Dachshund Rescue Inc.
Your Contact Info
First and Last Name
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Email
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Phone
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General Information
Name of dog
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Sex
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Male
Female
Age
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Coat Color and style
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Weight
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Does your dog have any physical impairments, mobility limitations, or bladder/bowel control issues (such as blindness, deafness, difficulty walking)?
What city is the dog in right now? Who is dog residing with currently?
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Reason for surrender?
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Did the dog come from another rescue?
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Yes
No
Unknown
If the dog came from another rescue, which one?
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Medical Information
Is dog spayed/neutered?
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Yes
No
Unknown
Are Veterinary records available?
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Yes
No
If available, complete veterinary records can be e-mailed to dxyldy4@aol.com or uploaded below. You may be able to contact your veterinarian directly and request that they send the records on your behalf. Please note that veterinary clinics typically require your authorization before releasing records to us.
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Has the dog been to the vet recently?
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Yes
No
Unknown
Please provide the Veterinary clinic name and contact information.
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Is your dog current on vaccinations (Rabies, DHPP, and Bordetella), deworming, and flea/tick prevention?
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Yes
No
Unknown
If yes, please provide the dates of the most recent vaccinations and treatments:
What is the condition of your dog's teeth? Please include any known dental issues, missing teeth, and the date of any recent dental cleaning or dental procedures.
Please list any allergies or skin issues?
Please list any health conditions and medications below?
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Behavior
Is your dog friendly with? (Mark all that apply)
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Adults
Children
Small Dogs
Large Dogs
Cats
Strangers
Please describe any behavioral issues or history of aggression, reactivity, anxiety, or other behaviors that could affect your dog's safety or placement. *This information will not affect whether we can accept your dog. We ask only to help ensure the safest and most appropriate placement.
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Which of the following training skills describe your dog? (Mark all that apply)
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Knows basic commands: Sit / Stay / No
Formal Obedience Training
No Formal Training
Leash Trained
Crate Trained
House Trained
Piddle Pad Trained
Other
What activities, toys, or hobbies does your dog particularly enjoy?
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Please share any funny quirks, unique habits, or humorous stories.
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Please upload at least three (3) photos of your pet. If you are unable to upload photos, please email them to dxyldy4@aol.com. *Applications cannot be reviewed until photos have been received.
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Please review our surrender guidelines at www.odr-inc.org/surrender. Oregon Dachshund Rescue, Inc. is a 501(c)(3) nonprofit that relies on donations to care for our dogs. We request a $100 surrender donation. Are you able to provide a $100 surrender donation?
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Yes
No
If Oregon Dachshund Rescue, Inc. is unable to accept your dog due to space limitations, foster availability, or other resource constraints, would you like us to share your dog's information through our network to help find a new home? In this case, you—not Oregon Dachshund Rescue Inc. —would be the contact person.
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Yes
No
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