Husky Animal Surrender/Intake Request

Dog Surrender/Intake Request
Your Name*
Your Email*
Your Phone*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Animal's Name*
Breed*
Color(s)*
Age/ Birthdate
Gender

femalemale
Has your dog had any vaccinations, heartworm testing, has it been altered (spayed or neutered)? If so, please describe.
What is your reason for surrender?
How Long Have you had the dog?
Where did you get the dog?
Does this dog have/had any known medical issues?
Dog’s Information-Behavioral Does this dog have any of the following behavioral issues? Please explain each issue. (Please be honest, it will let us know what things we should work on with the dog)

Separation or Other AnxietyChewingExcessive BarkingDiggingInappropriate UrinatingOver Protective of house, family, etcJumping UpBitting/AggressionFear of loud noises/objectsMy dog has none of these issues
Explain Any Issues Above (If Any)
Dog Is Good With

ChildrenCatsDogsOther (Plese List Below)
OTHER
Is your dog House Broken?
Has this dog had any formal obedience training?
Has this dog been crate trained?
Would it be okay if the new adopters of this dog contacted you?
Please upload a picture(s) of the dog (Pictures are strongly encouraged)

Upload a File

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Upload a File

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Would you be sending a donation if we are able to intake your dog? *
If everything is correct on the form , Please Type your name And Date .
Name
Date
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Dog Surrender/Intake Request