Surrender Questionnaire

Surrender Questionnaire

Type N/A for any questions you are unsure of.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pet Name*
Age/DOB*
Markings/Color*
Breed*
Sex*

MaleFemale
Approx. Weight*
Mircrochipped?*

YesNo
Microchip ID #
Is dog neutered/spayed?

YesNo
Why are you surrendering this dog? (Please provide as much information as you can.)*
How long have you owned the dog?*
Where did you get the dog?*
Have you asked friends or family for assistance in finding a home for your pet? If yes, please explain*
Has the dog ever bitten or attempted to bite a person?*

YesNo
If yes, who was bitten and where?
Date of incident

MonthDayYear
Date
Please explain the circumstances
I understand that if my dog is a bite risk, he/she may be returned to me depending on the severity of his/her case.

Yes I understand and will be available to take my dog back into my care up to 1 week post surrenderNo I am unable to take my dog back into my care once surrendered.
Has the dog ever*

ScratchedLunged or attackedNone of these
If yes, please explain the circumstances
Name of dog's veterinarian

First NameLast Name
Vet's Phone Number

Area CodePhone Number
Date of last vet visit

MonthDayYear
Date
Reason for last vet visit
Is the dog current on vaccinations?*

YesNoI don't know
If no, explain
Current illnesses, skin conditions, etc
Current medications being given and why
Brand and type of Heartworm Prevention given
Brand and type of Flea/Tick Prevention given
Please list any past or present injuries, other medical history, physical condition, allergies, restrictions, etc*
If you have documentation or the pets previous vaccinations, vet visits, etc, please email a copy to furangelfoundation@gmail.com
Has your pet had a fecal test done in the last 30 days?*

YesNo
Results?
Have you noticed any

FleasTicksWormsSores
Medication given
Is the dog potty trained?*

YesNo
Please explain (pad, outside)*
Is the dog crate trained?*

YesNo
Please explain*
Current food*
Any other details (good w/other dogs, kids, temperament, special needs, brushing teeth, exercise, traumatic experiences, etc.) and the frequency if applicable*
Digital Signature*

First NameLast Name
I understand that due to high volume of inquiries FAF cannot guarantee if or when they can take in my pet, however, FAF will contact me as soon as space becomes available. I understand it is my responsibility to follow up with FAF for updates on availability*

Yes, I understand.
If your pet is experiencing behavioral or medical issues ask your vet for assistance in managing these issues, and then reach out to a qualified trainer or behaviorist. See our website for resources.

Yes, I haveNo, I have notI will look into these options...
Additional resources to research to see if space is immediately available for your pet:

Hawaii Dog Foundation
OSPCA
Dog People of Oahu
PAWS of Hawaii

The submission of this form does not commit you or FAF to any binding agreement.

Fur-AngelFoundation | 590 Farrington Hwy #524-224,Kapolei,HI 96707
furangelfoundation@gmail.com | Ph:808.763.8662
Photo of Dog*

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Attach any medical docs for dog

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Click here to make a surrender donation.
Your donation covers a portion of medical care, food, and supplies.
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