Dog Surrender Form

Name:*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Date:*

Date

Animals Name:*

Age

Breed*

Upload a picture of your dog.*

Browse Files

Check the corresponding boxes to inform Saving Grace Animal Rescue Inc as to whether or not your pet has any behavioral concerns worth noting or working on with a professional trainer while in foster. Any items marked Yes or Maybe will be evaluated. Saving Grace DOES reserve the right to a 72 hour hold to do behavioral testing. If Saving Grace feels the pet is NOT a good fit for their adoption program, said pet will need to be picked back up. Please use the back of this sheet to elaborate on any items which you think require additional information

Is your dog an escape artist?*

YesNoUnknown

Does your dog struggle to be confined (in a crate)?*

YesNoUnknown

Is your dog reactive to seeing people when on leash?*

YesNoUnknown

Is your dog reactive to seeing dogs when on leash?*

YesNoUnknown

Is your dog destructive in the home?*

YesNoUnknown

Does your dog get anxious in the car/carsick?*

YesNoUnknown

Is your dog potty trained?*

YesNoUnknown

Is your dog protective of their food?*

YesNoUnknown

Is your dog protective of their toys?*

YesNoUnknown

Is your dog protective of their bed/space?*

YesNoUnknown

Is your dog protective of their siblings (if any)?*

YesNoUnknown

Is your dog protective of their handler?*

YesNoUnknown

Is your dog okay with children 0-2?*

YesNoUnknown

Is your dog okay with children 3-5?*

YesNoUnknown

Is your dog okay with children 6-12?*

YesNoUnknown

Is your dog okay with children 12+?*

YesNoUnknown

Has your dog ever lived with other dogs?*

YesNoUnknown

Has your dog ever coexisted with dogs smaller than them?*

YesNoUnknown

Has your dog coexisted with dogs larger than them?*

YesNoUnknown

Has your dog ever injured a dog?*

Yes (provide detail)NoUnknown

Has your dog ever lived with cats?*

YesNoUnknown

Has your dog ever injured a cat?*

YesNoUnknown

Has your dog been fearful of children?*

YesNoUnknown

Has your dog been fearful of men?*

YesNoUknown

Has your dog fearful of women?*

YesNoUknown

Has your dog enjoy playing with toys?*

YesNoUnknown

Has your dog enjoyed treats?*

YesNoUnknown

Has your dog ever injured a person?*

Yes (explain)NoUnknown

Notes/Reason for Surrender*

Our first mission is public safety. Our second mission is to save the animals. Saving Grace will NOT take in aggressive pets, this is worked on base to base cases. Saving Grace will NOT take a pet to have it euthanized for the owners. We will continue to make attempts to education and help train the community in spay and neuter.

We still have a high standard. We still do what is best for safety and our furry friends. Thank you for entrusting us and if you ever need anything...we are here!

Relinquishing Receipt for Animal Surrendered to Saving Grace Animal Rescue Inc by Owner*

I hereby give Saving Grace Animal Rescue Inc permission to request all medical history and medical records from my Veterinarian for the animal i am relinquishing.I acknowledge that my signature on this receipt relinquishes all claims of ownership of the animal(s) described. Neither my family, any representatives acting on my behalf, nor I may assert present and/or future claims, suites, or otherwise against Saving Grace Animal Rescue Inc with respect to this animal(s). I understand that the Saving Grace Animal Rescue Inc reserves the right to a 72 hour hold for behavioral testing and if Saving Grace feels the pet is NOT a good fit for their adoption program, I understand I MUST pick up dog as soon as possible.I acknowledge Saving Grace does NOT have to take in my pet

Signature*

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