Surrender or Emergency Boarding Request Form

Surrender or Emergency Boarding Request Form

Please complete this form with as much detail as possible. Submitting this application does not guarantee intake. DRDS accepts dogs based on available resources.
Your Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Organization Name (if applicable)
Full Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What is your relationship to the dog?
Dog's Name (if known)
Dog's Age (if known)
Breed (if known)
Weight/size (if known)
Is the dog microchipped?
Where is the dog currently located? (City/State)
How long have you had the dog?
Reason for needing emergency boarding or surrender (please be detailed)

How does your dog behave with the following?

Has the dog ever bitten a person?
If yes, describe the incident(s): Include triggers, severity, and medical outcome.
Has the dog ever bitten another animal?
If yes, describe the incident(s):
Describe the dog's overall behavior (check all that apply)
Is the dog house broken?
Is the dog crate trained?
Is the dog currently healthy?
Has the dog been spayed/neutered?
Is the dog up to date on Vaccinations?
Does the dog have any medical conditions? (please explain)
Requested intake type
When does the dog need placement?
Upload Images of the Dog
Upload Vet records, bite reports or supporting documents (if any)

Cancelof
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