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

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Important Notice

We are operating at full capacity so placements cannot be guaranteed until an assessment of dogs and availability of foster homes. Please note that due to risk we cannot place dogs with aggression and bite history into our foster homes
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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:

MaleFemale
Date of Birth:
Spay/Neuter:*

YesNo
If not spayed or neutered, please explain why not: *
Up to date on vaccines?*

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

YesNo
Microchip number and company name:
CKC Registered?

YesNo
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?

YesNo
WHERE IS YOUR DOG KEPT
While you’re out:

CratedLoose in houseOutside
At Night?

CratedLoose in houseOutside
During the Day

CratedLoose in houseOutside
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:

Very HighHighMediumLowVery Low
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:

PersonDogOther Animal
Please explain the circumstances:
Has your dog ever shown aggression to:

PersonAnimalNone
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:

PersonDogOther
How does your dog react to strangers:
Does your dog know basic commands?

SitStayComeLay Down
Other commands or tricks?
What is your dog’s general temperament?
Can you disturb the dog while: (Please check off appropriate)

EatingPlaying With ToysSleepingChewing a Bone
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.
Date

MonthDayYearHourMinutesAM/PM Option
Your name*
Should be Empty:

Important Notice