Dekalb Humane Society Online Applications

DeKalb Humane Society Surrender Request

5730 County Road 11A

Auburn, IN 46706

260.868.2409

Please fill out all fields marked with an asterisk (*) to complete the form. Application will not be processed if it's incomplete. Please call to check on your application status.

Owner Information:
First name *
Last name *
Street address *
City *
State *
Zip code *
Phone number *
Cell Phone
Email address *
Information on animal needing rehomed:
Name of pet * Name of pet
Species * Species of pet
Primary breed (if unknown, guess based on appearance) *
Secondary Breed (If purebred, type same breed as above)
How old is the pet (if unknown, estimate)? *
Where did you originally acquire the pet? *
How long have you owned the animal? *
Please give a brief description of the appearance of the pet *
Estimated weight * Closest estimate to animals weight
Reason for surrender (be as detailed as possible): *
Behavior History: Please answer to the best of your knowledge. This will help ensure the best and safest placement for the pet.
Has the animal ever showed aggression of any sort? * Includes resource guarding, bites, nips, scratches, growls, etc.
If so, please explain *
Has the animal ever bitten anyone? *
Was a doctor/ER visit required? *
Please explain the circumstances of the bite(s). Be as detailed as possible. *
Does the pet do well with dogs? *	Yes No Selective Unknown
If selective, please explain: *
Does the pet do well with cats? *	Yes No Selective Unknown
If selective, please explain: *
Does the pet do well with children? *	Yes No Selective Unknown
If selective, please explain: *
What are your pet's best qualities? *
Does your pet tolerate nail trims? *	Yes No Unknown
Is your pet housetrained? *
How often does your pet go out to potty? *
How does your pet let you know they need to go out?
How does your pet react to being left alone? *
Write an adoption plea for your animal. * Be as detailed and positive as you can.
Is there anything about your pet you think the new owners should know?
How do you correct/dicipline your pet? *
Medical Information:
Is the animal spayed/neutered? *	Yes No Unknown
Is the animal current on vaccines, including rabies and distemper? *
Is the animal microchipped? *	Yes No Unknown
Name of the vet where the animal has been seen
Name the animal's records would be under at the vet:
Does the animal have any known medical issues? *
If yes, please explain:
Is the cat declawed? *
Please upload a copy of the pets medical records if you have them.
Submitting this form means your animal will most likely be posted on our Facebook page/website to help you network for a home. What contact info would you like used for this post? * Email/phone/etc.
I understand and agree to the following:
*	Filling out this request does not guarantee placement of my pet.
*	If my pet is deemed a behavioral risk or becomes medically frail at any time they may be euthanized. I will not be contacted about this decision.
*	If I wish to reclaim my pet, I will have to go through the normal adoption process.
*	There will be a surrender fee if my animal is taken in.
*	The above form is filled out to the best of my knowledge.
*	If an appointment is made to intake my pet and I am late to or miss my appointment, my animal is not guaranteed an intake or new appointment.
*	Animal abandonment is a crime. If the shelter is not able to take in my pet, I will find alternate responsible placement for the pet. If it is discovered I abandoned the pet, I will be prosecuted.
Signature (Please use your finger,stylus or mouse.) Use finger, stylus or mouse.
Date *
Please list any additional information you feel is important for us to know.
Current photo required. Request will not be processed without photo. *

260.868.2409.