Intake Request Form

Intake Request Form

Note: All questions must be fully answered to be considered for intake. Completing an intake request does not guarantee a dog can be surrendered to Happy Tails Canine Rescue.
What is the name/ age/ sex/ weight/ breed of the dog you are wanting to surrender?:
Name:
Age:
Sex:
Weight:
Breed:
Upload 2-3 clear photos in good lighting of the dog. The more photos, the better:

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How long has this dog been in your care?
Why are you wanting to surrender the dog? Provide as much detail as possible.
Has the dog had any prior professional training? Be as detailed as possible.
Has the dog shown any signs of aggression? Provide as much detail as possible so we can know any training needs.
Is the dog good with all adults:
Is the dog good with children:
Is the dog good with other dogs:
Is the dog good with cats:
The dog is heartworm negative and I can provide proof from a vet:
The dog is microchipped and I can provide the microchip number:
Microchip company and microchip number:
The dog is up to date on all vaccines and I can provide proof from a vet:
The dog is spayed or neutered and I can provide proof from a vet:
I am willing to foster the dog through your rescue until the dog finds a home:
I am willing to sponsor the dog's medical care and cover the cost of their vet bills:
I am willing to make a donation to the rescue to help cover expenses for the dog:
If you are willing to donate to the care of the dog, how much are you wiling to donate?:
Each intake request is taken to the board and voted on by our active members. Although, we would love to help every dog that comes our way, we get several requests daily and have limited resources. A request that gets denied will be because of inadequate funding, no available foster, or the dog's medical care/ training needs is beyond our capacity. For each dog we take in our rescue, we spend an average of $300 on their prevention, food, and supplies while they are in our care. To fully vet a heartworm negative dog in our rescue, the average cost is $500. Heartworm positive dogs have another set of expenses. We rely 100% on donations and our ability to provide the best care for each dog in our rescue. Right now, we are trying to only accept fully vetted dogs in our program so if the dog is up to date on medical care and altered (or you have a sponsor or are willing to make a donation for the dog), they have a better chance of being accepted into our program. For puppies, we would need a negative parvo and distemper test, and at least their first round of vaccinations.
Your Legal Name:

First NameLast Name
Signature
Your Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Your Email:
example@example.com
Date

MonthDayYear
Date
How did you hear about our rescue?:
Should be Empty: