Owner Surrender Form

You can also upload a picture and/or your completed owner surrender form which is posted on our website at www.freedomdogrescue.ca

Upload a File

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Important Notice:

It appears that you are submitting this form from outside of Canada. Freedom Dog Rescue is a 100% volunteer-run, foster-based rescue located in Ottawa, Ontario, Canada. As such, we are only able to assist when there are foster home commitments within our support area.

All owner surrenders must be assessed by our team before we can consider taking a dog into our care. Unfortunately, since you are outside our current volunteer support region, we are unable to assist.

We encourage you to reach out to your local humane society, animal rescue organizations, or shelters for assistance. We sincerely apologize for any inconvenience, and we thank you for your understanding.

Do you live 1+ hour drive away from Ottawa Ontario Canada

Important Notice:

It appears that you are submitting this form from outside the Ottawa area. Freedom Dog Rescue is a 100% volunteer-run, foster-based organization located in Ottawa, Ontario, Canada. Due to our limited resources, we are only able to assist when foster homes are available within our support area.

Please note that all owner surrenders must be assessed by our team before we can consider taking a dog into our care. By submitting this form, you agree to bring the dog to the Ottawa region for assessment by our volunteers. If you are unable to make the trip for this assessment, we regret that we will be unable to proceed with the surrender request.

We encourage you to reach out to your local humane society, animal rescue organizations, or shelters for assistance. We sincerely apologize for any inconvenience and thank you for your understanding.

E-mail

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

How did you hear about Freedom?

How long did you have the dog?

Where did you get the dog from?

Are you the original owner?

Why are you contacting us? Please be specific.

About Your Dog

Name:

Breed:

Age:

Weight:

Physical description (please include colour, length of fur etc.)

Sex:

Date of Birth:

Spay/Neuter:

If not spayed or neutered, please explain why not:

Up to date on vaccines?

If vaccinated please list with what (it DHPP, Rabies, Bordetella) and when it was done

Microchip:

Microchip number and company name:

CKC Registered?

Breeder Information:

Tail docked?

Tattooed?

Please provide other vetting information

If your dog comes into Freedom are you willing to give us copies of Vaccinations and veterinary paperwork?

WHERE IS YOUR DOG KEPT

While you’re out:

At Night?

During the Day

Is your dog an indoor dog or outdoor dog?

If outside, please explain why?

How long is your dog left at home alone?

PERSONALITY AND BEHAVIOUR

Does your dog jump fences?

Does your dog like car rides?

Is your dog good with cats?

Describe your dog’s activity level:

Has your dog had any obedience training?

Specify the Obedience School:

Has your dog been protection trained?

Does your dog have any destruction habits?

Specify:

Is your dog house trained?

Is your dog crate trained?

If yes, when does your dog go into the crate and for how long?

Has your dog been around children?

Do you have children?

List their ages:

Any aggression towards children?

Has your dog ever bitten, nipped or snapped?

If so:

Please explain the circumstances:

Has your dog ever shown aggression to:

Please explain the circumstances:

Do you have another dog living in the house?

Does your dog aggressively guard food, toys or people?

How does your dog react to other dogs?

How does your dog react to dogs that visit your home?

How does your dog react to other dogs at the park or on walks?

Does your dog bark or growl aggressively at people or other animals

How often do you walk your dog?

Does your dog walk well on a leash?

Is your dog shy or afraid of anything?

Has your dog ever bitten?

If so:

How does your dog react to strangers:

Does your dog know basic commands?

Other commands or tricks?

What is your dog’s general temperament?

Can you disturb the dog while: (Please check off appropriate)

What are some of the things your dog likes?

What are some of the things your dog does NOT like?

What type of home would you feel would best suit your dog?

If we are able to find a suitable home for your dog, are you able to pay a surrender fee to Freedom Dog Rescue to assist us in continuing our work helping other dogs?

HEALTH AND CARE

What is the general health status/general condition of your dog?

List any major medical conditions or surgeries your dog has ever had:

List medications:

Monthly cost:

Date of last vet check:

DHLP:

Rabies:

On heartworm meds:

Brand:

Next vaccinations required:

Date of next heartworm treatment:

Dog Food Brand:

Amount fed?

How often fed?

Please list your current Veterinarian’s information and give them permission to discuss your pet’s file with a member of our team.

Name:

Address

Telephone Number

We require vet records. Are you willing to provide us with this?

PERSONAL REFERENCES
Please provide contact information for three different people who are personally familiar with your dog’s character.

Name #1 :

E-mail:

Tel:

Relationship:

Name #2 :

E-mail:

Tel:

Relationship:

Name #3:

E-mail:

Tel:

Relationship:

Are you able to pay an owner surrender fee? (this fee is to help off set some of the costs associated with vetting, food, dogs needs when we take in a dog):

What is amount you are able to pay:

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I certify that the above information is correct, and I understand that the information will be verified.

I agree to have FREEDOM DOG RESCUE complete reference call checks.

Email this form along with current photos of your dog to: freedomdogintake@gmail.com

Plase note that if Freedom Dog Rescue take in your furbaby you are required to have vetting paperwork on hand on day of assessment.

I certify that the information provided on this form is true and correct. I understand that by providing this information I am under no obligation to relinquish my dog to FREEDOM DOG RESCUE nor is FREEDOM DOG RESCUE under any obligation to accept my dog.

Vetting record of the dog seeking rescue

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