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 Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Organization Name (if applicable)
State/City/Zip Code
*
What is your relationship to the dog?
*
Dog's Name (if known)
Dog's Age (if known)
Breed (if known)
Is the dog microchipped?
*
Yes
No
Unknown
Where is the dog currently located? (City/State)
*
How long have you had the dog?
*
Reason for needing placement or surrender (please be detailed)
*
How does your dog behave with the following?
*
Rows
Excellent
Good
Fair
Poor
Unknown
Children
Strangers
Dogs
Cats
Women
Men
Has the dog ever bitten a person?
*
Yes
No
If yes, describe the incident(s): Include triggers, severity, and medical outcome.
Has the dog ever bitten another animal?
*
Yes
No
If yes, describe the incident(s):
Describe the dog's overall behavior (check all that apply)
*
Friendly
Shy/Timid
Aggressive
Protective
Reactive
Energetic
Calm
Anxious
Guards Toys, Food, People etc
Separation Anxiety
Is the dog house broken?
*
Is the dog currently healthy?
*
Yes
No
If no, please explain the dog's current health issues.
Has the dog been spayed/neutered?
*
Yes
No
Unknown
Is the dog up to date on Vaccinations?
*
Yes
No
Unknown
Does the dog have any medical conditions? (please explain)
*
Requested intake type
*
Please Select
Full Surrender
Emergency Boarding (30-60 days)
When does the dog need placement?
*
Upload Images of the Dog (if available)
Upload Vet records, bite reports or supporting documents (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Request
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