Surrender Request Form

Surrender Request Form

surrender@doghouserescueacademy.org • PO Box 1012 Alva FL 33920
Please keep in mind this is a request form that will be evaluated by a rescue representative. If we have an available foster and funds to take in your pet, we will contact you to complete the surrender process - THIS SURRENDER REQUEST FORM IS NOT A GUARANTEE WE CAN TAKE IN YOUR PET. If you found a lost or stray animal, by law we are not allowed to take it in and it must be processed through Lee County Domestic animal Services (more information here: leegov.com/animalservices/foundpet). If found outside of Lee County, research and contact animal services for the area the animal was found.
Date*
Owner Information
Owner Name*

First NameLast Name
Owner Mobile Phone Number*

Area CodePhone Number
Owner Email*
Primary Email
Dog Information
Please write the 1) name, 2) breed(s) 3) age, and 4) sex of the dog(s).*
How did you get the dog(s) and how long did you have it for?*
Are your dog(s) spayed/neutered?*

YesNo
Do you have proof of vaccines?*

Yes - my dogs are vaccinated and I DO have vet recordsYes - my dogs are vaccinated but I DO NOT have vet recordsNo - my dog is NOT VACCINATED
Is the dog good with*

DogsCatsSmall AnimalsFarm AnimalsNONE - MUST BE THE ONLY PETOther
Owner's Reason for Surrender*
List any medication(s) or allergies for the above mentioned pet(s):
List any particular concerns or things the rescue should know about the animal(s) - good and not so good:
Attach any photo(s) you have of the dog

Browse Files

Cancelof
Vet Information
Vet's Name & Address

Veterinarian Name

Street Address

CityState

Zip Code
Vet's Phone Number

Area CodePhone Number
Do we have permission to contact your vet and ask questions about the pet(s) above?*

YesNo
The animal(s) I am doing a Surrender Request Form stated above are my own animals and are not lost/strays I have found*

I have read and understand the above statement - the animal(s) on this form are not lost or stray animals
Should be Empty:

Surrender Request Form

Owner Information

Dog Information

Vet Information