Dog Surrender/Intake Request

P.A.W.S. Dog Surrender Request Form

This form signifies your intent to surrender a dog to the shelter and places you on the waiting list. Persons who surrender a pet to the shelter will not be eligible to adopt the animal back at any time. If you have more than one animal, please submit a form for EACH animal.
*** P.A.W.S. reserves the right to refuse any animal that displays aggressive behavior at the time of surrendering, has a history of aggressive behavior, and/or bite history. ***
Your Name *
Your Email *
Your Phone *
Your Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Why do you want to surrender this animal? (check all that apply) *

Financial Reasons Behavioral Reasons Moving and cannot keep the animal Change in family Insurance company will not allow this breed/size of animal Personal Illness Animal has an illness Got another pet
Animal's Name *
Breed *
Color(s) *
Weight
Age:
Socialization *

Sweet and social A little shy but warms up when you're nice Very shy Fearful Aggressive High Energy
Is this dog good with other animals (cats/dogs)? if no, please give some details. *
Where did you get this dog? *
How long have you had this dog? *
Please describe in detail why you want to surrender this dog? *
Is this dog spayed / neutered? *

Yes No
Had your dog had the following vaccinations/Treatments in the past 12 months? *

Rabies Lime Lepto Flea / Tick Heartworm
When was the last time you administered a flea & tick preventative
When was the last time you gave tour dog heartworm prevention medication?
Does your dog have any medical conditions, medications, special diets, etc.... please explain:
Can you provide vet records for this animal? *

Yes No
If you have taken this animal to the Vet, please provide the Veterinary contact info (clinic, Dr. etc)
How does this dog behave at the Veterinarians Office? (Shy, Fearful, Muzzled, etc...) *
Is this dog house trained? *

Yes No Unknown
Does this dog haveaccidents in the house?
Does this dog chew / destroy household items? *
Is this pet confined to a certain area of the home? *
How long was the animal left alone on the average day? *
Does this dog, ignore, play with, is bossy withor grouchy with any of these other persons or pets? *
Would the dog rather play/be with the kids, avoid or be left alone, ignored? *
Would the dog need to be taught to be gentler? *
Is the dog rough or mouthy? *
Can this dog climb a fence? *
Will the dog come when you call him/her? *
Does the dog get leashed walk? *
What is the dog’s reaction if it sees a strangedog? *
What do you feed this dog, how much and how often? *
Is this dog food aggressive/possessive? *
Have you or anyone tried to pet or approached the dog while he/she was eating? What is the dog’s reaction to this? *
What is the dogs reaction to visitors/strangers? (Greets happily / Barks then calm / Jumps on People / Hesitant by friendly / Hides / Growls / Bites) *
How long does it takethe dog to calm down with visitor/strangers? *
Has the dog evernipped or bitten anyone? If yes, please explain the circumstance. *
How is this pet aroundchildren? *
What parts of the bodydoes the dog not like being handled or touched? *
What is the dog’s reaction to this? *
Can you or anyoneremove toys, garbage, bones (treats) from the dogs mouth? If no, please explain: *
What are the dogs best qualities? *
What are the dogs worst qualities? *
how do you discipline the dog? *
Who does the dog listen to best? *
What commands does thedog know? *
Any additionalcomments are always helpful: *
Please attach a photo of the dog.
I confirm that the information that I have provided about this surrendered animal(s) is, to the best of my knowledge, a true and accurate depiction of its health, temperament, and behavior. I am verifying the truth of the above information and I understand that I can be held legally responsible for any medical care or other damages that result from false or misleading information on this form. I understand that by surrendering ownership of this animal(s), I am forfeiting the right to adopt this animal(s).

I also understand that there is a surrender fee for this animal and I am responsible to pay this at the time of surrender.
- Submitting this form does not confirm that we will accept your animal.
- You will be contacted within 48 hours with additional information.
- Please take note that we often have a waiting list for dogs. But we do the best we can to accomodate persons in the communities we serve.
Just to be clear. When you surrender an animal, you will not be allowed to adopt this animal back at any point.
Please use your mouse (computer) or stylus (tablet) to sign your name: *
Should be Empty:

P.A.W.S. Dog Surrender Request Form