Dog Surrender Request Form

Dog Surrender Request Form

Please complete this form to provide information about the dog you are wanting to surrender. Your answers will help us find the best possible placement for your dog. Please note that completion of this form does not guarantee a foster place for your dog. Placement depends on the availability of a suitable carer.
Your Full Name*

First NameLast Name
Your Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Your Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Your Email Address*
example@example.com
Dog's Name*
Dog's Age*
Dog's Breed*
Dog's Sex*

MaleFemaleOther/Unknown
Is the dog desexed (spayed/neutered)?*

YesNoUnknown
If your dog is not desexed and is female, is there any chance the dog could be pregnant?

YesNoUnknown
Is the dog microchipped?*

YesNoUnknown
Microchip number if known:
Is your dog up to date with vaccinations?*

YesNoUnknown
If you chose "yes", we will require the vaccination card for proof of vaccination
Date next vaccination due:
Is the dog good with other dogs?*

YesNoUnknown
Is the dog good with cats?*

YesNoUnknown
Is the dog good with children?*

YesNoUnknown
Does the dog have any of the following behavioural issues? (Select all that apply) Behavioural issues will not automatically exclude your dog from our foster care program, but will help us know if we have a carer who can cater to your dogs training requirements*

DiggingBarking excessivelyChasing other animalsJumping fencesHas shown signs of aggression to peopleHas shown signs of aggression to other dogsChewing itemsPulls on leadWon't come back when calledNone of the aboveOther (please specify)
Please specify if you chose 'Other'
Dog's Personality

Ie, boisterous, calm, anxious, high energy, couch potato etc
Describe the dog's personality*
Does your dog have any medical issues or any special food requirements? Please specify all issues we should know about. Having a medical issue will not mean your dog will be automatically excluded from our program but it will help us ensure we have a carer who can cater to your dogs needs. *
Is the dog house trained?*

YesNoPartiallyUnknown
Please explain the reason for surrendering the dog*
By signing this form, you acknowledge that you are giving up all rights to the dog if they are accepted in to our foster care program and that you are the legal owner of this dog and have the right to surrender the dog.
Signature (please sign to confirm the information provided is accurate)*
If you have nice photos of your dog you would be happy for us to use for advertising please feel free to add them here. This also helps us create your dogs profile in our database. (This is completely optional).

Cancelof
Should be Empty:

Dog Surrender Request Form

Dog's Personality