Dog Surrender

Dog Surrender
Before we can take custody of your animal, we require the submission of a signed surrender form. Being the owner of the animal described below; I do hereby surrender the animal to Diane's Pet Rescue. I fully acknowledge that by signing this document, the animal immediately becomes the property of Diane's Pet Rescue.*
(Initial)
Once your form is submitted, our intake team will reach out to you if your pet meets our requirements. We only accept dogs that are social, good with other dogs & people. If your dog fits that criteria, please fill in and submit this form and follow the instructions at the bottom for sending us photographs. *
(Initial)
Diane's has generously agreed to assist you in placing your pet in a new home. The terms of this agreement are as follows: If for any reason Diane's decides to no longer assist you in placing your pet, you will take the animal back into your possession within 24 hours of being notified.*
(Initial)
This animal has not bitten anyone or injured another dog or cat.*
(Initial)
I agree to all the terms above.*
(Initial)
Signature

Powered by Jotform SignClear
Has this dog ever bitten, snapped at or growled at anyone?*

YesNo
If your dog has a human or dog bite history? Please describe the circumstances behind the bite, the severity and how many times bites have occurred.
Your Name*
Your Email*
Your Phone*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Animal's Name*
Breed*
Color(s)*
Age *
Approximate Weight*

under 5 lb5-9 lb10-14 lb15-20 lb21-30 lb31-45 lb46 -55 lb56-65 lb66-75 lb76-85 lb86-96 lbover 100 lb
What is your reason for surrender?*
Please describe the actions you have taken so far to keep your dog with you and why those actions have not worked.*
If your dog was a rescue where did you adopt him from?
If your dog was a rescue, have you contacted the organization to see if they can take the dog?
Does your dog have any medical conditions that require treatment? Has he/she had any conditions in the past that have been treated?*
Has your dog had any vaccinations, heartworm testing, has it been altered (spayed or neutered)? If so, please describe.*
Medical Records

Browse Files

Cancelof
Socialization People*

LOVES EVERYONESweet and socialCuddly lap dogVery shyDoes not like strangersProtective of ownerDefinitely abusedFear biterA little shy but warms up when you're nice
Does your dog like people?*
What age children is your dog comfortable with?*
Does your dog get along with other dogs? If so please explain.*
Does your dog like cats?*
Does your dog have any behavioral issues? If yes, Please describe*
Please tell potential adopters some great qualities about your dog.*
Activity Level*

Needs lots of exercise- very activeVery relaxed indoors but loves to play outdoorsNeeds about 1/2 hr. of exercise dailyCouch PotatoNeeds another dog to play with
What brand dog food does your dog eat? What is his feeding schedule?*
Where does you dog sleep?*
Where does your dog spend most of his/her day?*
Is your dog completely housetrained?*
Please describe your dogs bathroom habits. *
What level of training does your dog have?*

leash trainedcomes when calledsome basic commandsall basic commandsobedience trained myselfprofessionally obedience trainedtricksOther
Please describe in detail the level of training below.*
Amount of donation offered to help us cover the cost of vetting/caring for this dog?
Please take 4 good quality, well lit photographs of the dog and upload them below or email them to us at dianespets1486@gmail.com with your name and the animal's name in the subject of the email. If you have any videos of the dog, please upload one below or send us the link to them on youtube.
upload photos

Upload a File

Cancelof
video

Upload a File

Cancelof
video link
Should be Empty: