Pet Surrender Form

Dog Surrender Form

Please note, in order to submit this form, we require certficates for microchip, vaccination and desexing. If unavailable, please email us at dogintakes@maggiesrescue.org.
Dog's Name*
Gender*

FemaleMale
Breed & colour*
Age*
Size*
Reason for surrendering*
Please provide a description of your pet*
Please check all that apply *

MicrochippedDesexedVaccinatedHeartworm tested / treated (dogs only)WormedFlea treated
Has your dog undergone any behavioural training? If so with whom?*
Please provide name and contact details of Behaviourist
Does your dog have any medical condition that we should know about?*
Current Vet Name: *
Vet Phone Number:*

Area CodePhone Number
Vet Email: *
example@example.com
Please attach microchip information*

Upload a File
(Max 5MB, image or PDF preferred.) Cancelof
Please attach desexing certificate

Upload a File
(Max 5MB, image or PDF preferred.) Cancelof
Please attach vaccination records

Upload a File
(Max 5MB, image or PDF preferred.) Cancelof
Is your pet...*

Toilet trainedGood with catsGood with other dogsGood with childrenGood on a leadGood in the carCrate trained
When your dog is left alone, it is

Only outsideOnly insideHas access to both
Tick any of the following that describes your dog

Barks excessivelyPulls on leadIgnores requests/commandsDigs excessivelyDoesn't bark muchChases thingsDoes not come back when calledLikes to retrieve itemsIs calm in the carDestructive behaviours
What is your pet's ideal home?*
Pet's energy level*
Pet's suitability to other cats/dogs*
Pet's suitability to children*
Photos of your pet*

Upload Images
Images and PDFs only. Each file max 5MB, max 5 files. Cancelof
Your Information
Full Name*

First NameLast Name
Email Address*
example@example.com
Would you like to receive emails from Maggie's Rescue about news, events and fundraising?

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If the pet does not live with you at the above address, please specify its location
Primary Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Any additional information we need to know?
Please note that there may be a surrender donation which is payable upon acceptance of your dog into our care. This helps to cover the costs associated with the care and rehoming process.

$450 non desexed dogs

$350 desexed dogs
Should be Empty: