Owner Surrender Request

Owner Surrender Request Form
We ask for you to be willing to transport the dog you are surrendering to the Dayton or Columbus area based upon our availability. Our ability to bring dogs into the rescue is based on having a suitable foster home or an available spot in our training program, as well as our available funding for extensive medical issues, our fosters' level of experience, and history with our ability to place your dog. We do not accept bite risk or aggressive dogs, and are sometimes limited in which breeds we can take based upon the rules of the correctional institution. We are a rescue overwhelmed by the volume of pets needing rehomed, as are all other rescues and shelters. Additionally, we are 100% volunteer-based, so please be patient in awaiting a reply from us. If you are able to bring your dog up to date on vaccines and have them spay/neutered, that will assist in our ability to take them sooner. Thank you!
Owner Name*

First NameLast Name
Address (no P.O. Boxes please)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Best time to call?*
E-mail*
What is the dog's name?*
Gender?*

MaleFemale
What is the breed or mix?*
Why are you surrendering the dog?*
Approximate age of dog?*
How much does the dog weigh (or an approx estimate)?
Is the dog spayed or neutered?*

YesNo
Is the dog current on vaccines?*

YesNo
Heartworm prevention (such as Heartguard, Tri-Heart, etc)?*

YesNo
Is the dog an inside dog?*

YesNo
If no, please explain
Does the dog get along with other dogs?*

YesNoDon't know
Does the dog get along with cats?*

YesNoDon't know
Do you trust your dog around children? Please explain their exposure and to what age of childern, if any*
Does the dog have any behavior issues: dog aggression, aggresion towards people, children, food, toys, separation anxiety, housebreaking, etc. Please explain in detail.*
Does the dog have any health issues?*

YesNo
If yes, please explain
Has the dog ever bitten anyone? Including another animal. You ARE required by law to disclose any bite histories. Failure to do so can result in legal action against you.*

YesNo
If yes, please explain
Please provide your vet's name, address, and phone number used for this dog. Please notify the vet that we will be contacting them and provide consent to release information to us. This will prevent delays in processing your request.*
Did you previously adopt this dog from a rescue or animal shelter?*

YesNo
If yes, please list who you adopted the dog from. You are required to contact the agency you adopted the dog from as typically they require return of said dog. Please be prepared to show that the agency will NOT take the dog back.
Did you purchase this dog from a breeder? If yes, you are required to contact the breeder first as a reputable breeder will always take one of their dogs back. Please be prepared to show that the breeder refuses to take the dog back.*

YesNo
What other efforts have you made to rehome the dog and are any options ongoing? Have you contacted other rescues or posted the dog publicly on any rehoming sites? Please provide details.
Any additional comments that will helps us?
Should be Empty:

Owner Surrender Request Form