Owner Surrender Form
Applicant and Contact Information
Full Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Dog Identification and Basic Details
Please let us know why you would like to surrender your dog to Houston Eskimo Rescue.
*
Is this a dog you own, or found as a stray?
*
Own
Found as stray
Dog's Name
*
Dog's Breed
*
Dog's Gender
*
Male
Female
Dog's Approx. Age
*
Dog's Approx. Weight in Pounds
*
Is the dog spayed/neutered?
*
Yes
No
Behavior, Health, and History
Please describe the dog's temperament.
*
Has the dog ever bitten anyone (drawn blood)?
*
Yes
No
Was the bite reported and/or the dog quarantined?
*
Yes
No
If you answered yes to the questions above regarding bites, you may give more details here.
Has the dog been around other dogs, cats, kids? Please describe in detail what the dog has been exposed to and their reaction.
*
Where is the dog currently located?
*
Are you able to foster (physically house the animal) during the adoption process?
*
Yes
No
Has the dog received any veterinary care - such as worming, vaccinations, heartworm testing, monthly heartworm preventative medication? If yes, who was the treating vet?
*
Please upload any veterinary records, vaccination records, or other medical records you have for the dog.
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Is there any additional information you would like to share?
Please upload current photos of the dog.
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Agreement and Certification
I understand that if the dog is accepted into Houston Eskimo Rescue's adoption program and physically relinquished to one of HER's representatives, ownership will transfer to Houston Eskimo Rescue.
*
I understand and agree to these conditions
I certify that the information provided above is accurate to the best of my knowledge.
*
Yes, I certify information provided is accurate
Submit
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