Contact Info
First Name *
Last Name *
Street Address *
City/ Town *
State *
Zip Code *
Primary Phone *
Secondary Phone
Email *
About Your Dog
Dog's name *
What is the dog's primary breed? *
Dog's age (Please specify years, months, or weeks) *
Dog's sex *
Female Male
Is the dog spayed/ nuetered? *
Yes No
Dog's weight? *
Please describe the reason for the dogs surrender. *
How long have you owned the dog? (Please specify years, months, or weeks) *
Where did you get the dog? *
Breeder
Facebook
Friend/Family
Craigslist
Rescue Organization
Shelter
Other
If you answered rescue, shelter, or other please specify where the dog came from. *
Is your doog good with... (Select all that apply) *
Other Dogs Cats Children Dog Parks Doggy Daycare
Other Dogs
Cats
Children
Dog Parks
Doggy Daycare
Are there other pets in the home? I yes please list them here. *
Are there any children in the home? (Select all that apply) *
No Yes, under 5 years old Yes, 5 - 12 years old Yes, over 12 years old
No
Yes, under 5 years old
Yes, 5 - 12 years old
Yes, over 12 years old
Has the dog been seen by a veterinarian? *
Yes
No
I take the dog to clinics
Name of the vet/ clinic that the dog been to. *
Veterinarian's phone *
What current vaccinations does the dog have? *
Select all that apply
None Rabies Bordatella Distemper/Parvo Lyme Lepto
None
Rabies
Bordatella
Distemper/Parvo
Lyme
Lepto
I understand that i need to email a copy of my dogs medical records to adoption@helpinghoundsny.com *
Yes
Whose name are the vet records under? *
Please include a photo of the dog *
Have you tried to surrender your dog to any other shelters/rescues? *
No Yes
If yes, what organizations have you tried? *
What reason did the organization give as to why they couldn't help your dog? *
By submitting this form you understand Helping Hounds Dog Rescue will be contacting your vet. You authorize that your vet can share all records about your dog and your dog's medical history with Helping Hounds Dog Rescue.