Surrender Form

Oregon Dachshund Rescue, Inc. Surrender Form
Thank you for contacting Oregon Dachshund Rescue about your surrender. Please fill out as much of the information below as you can. This will help us find a home for your Doxie.
Your Contact Info
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
General Information
Name of dog*
Gender*

MaleFemale
Age
Color
Coat
Weight
Please list any impairments (blind, deaf, etc.)
Location of dog:*
Reason for surrender?*
How long have you had the dog?*
Did dog come from another rescue?*

YesNoUnknown
If so, which one?
Medical Information
Is dog spayed/neutered?*

YesNo
Are Veterinary records available?*

YesNo
If so, complete vet records can be faxed to (360)225-7911, or attached by using the upload buttom below. You could probably contact the vet and request them the do this for you. They will not release the information to us with out your approval.
Upload vet records here if available.

Upload a File

Cancelof
Vet contact if known:
Has the dog been to the vet recently?*

YesNoUnknown
Is the dog up to date on all immunizations (Rabies, DHPP, Bordatella)?*

YesNoUnknown
When was dog last wormed?
When was last flea treatment?
What is the condition of the dog's teeth? Please include any recent dental work or cleaning.*
Please list any allergies.*
Please list any skin issues.*
Please list any medications below.*
Please list any health issues below.*
Behavior
Is the dog okay traveling in the car?*

YesNoUnknown
Is the dog friendly with children?*

YesNoUnknown
Is the dog friendly with cats?*

YesNoUnknown
Is the dog friendly with other dogs?*

YesNoUnknown
Is dog leash trained?*

YesNoUnknown
If no, please explain.
Please explain any behavioral issues the dog has.*
Has the dog received any obedience training?*

YesNoUnknown
Does the dog know basic commands (sit, stay, no, etc)?*

YesNoUnknown
Is the dog house trained?*

YesNoOn piddle pads
Please let us know what activities the dog particularly enjoys.*
Please let us know any humorous behaviors or stories.*
Please upload a photo of your pet,*

Upload a File
Pictures should be of the dog only, no other dogs, cats, kids, people, etc. JPEG, PNG or PDF under 10MB please. Cancelof
In the event that we cannot take in your surrender due to being overfull or the like, we will still help you place your dog using our network to share, in which event YOU will be the contact, not ODR, Inc. Is this ok with you?*

YesNo
Please refer to www.odr-inc.org/surrender for the guidelines to a successful surrender. ODR, Inc. is a 501 (c)3 and relies entirely on donations to care for our dogs. We ask for a $100 surrender fee. Are you able to donate $100 for the surrender.

YesNo
Should be Empty:

Oregon Dachshund Rescue, Inc. Surrender Form

Your Contact Info

General Information

Medical Information

Behavior