Humane Society of Kodiak Dog Surrender Profile & Release Form

Answering these questions honestly will not stop HSK from admitting your pet but will ensure that we are able to provide the correct care for your pet.

Owner Information
Person providing information *
First name *
Last name *
Address *
Telephonenumber *
Emailaddress
Pet Information
Please explain why you are surrendering your pet? *
Where did you get your pet?
If you said other to the above, please explain
Pet Species *
Animal Name *
Breed *
Cross breed, if any
Sex *
Pet Markings *
Age and/or date of birth *
Is the animal up to date with its annual vaccinations? *
Has the animal been neutered? *
Is the pet housetrained? *
Is the pet crate trained?
Do you leave the animal alone for any period of time? If so, how long for and do you have concerns about them being on their own? *
Where does the animal sleep? *
Has the animal ever been destructive in the house? Please describe *
Does the animal travel well in cars? *
Will the animal give up toys when commanded to?
Would you describe your animal as a gentle player or does he/she like "rough" play? Describe your animal's play activity, eg. favourite game, favourite toy, etc. *
How does your animal react to grooming and nail trims? *
How does your animal behave at the vet? *
How does your animal react when he/she has done something wrong? How do you "tell him off"? *
Does your animal return when called whilst off the lead? *
Has the animal lived with children? *
If so, please specify ages
If no, has the dog met children and what was his/her reaction?
What age groups were any children met?
Has the animal lived with dogs? *
If so, please specify age and sex
Has the animal lived with cats? *
If so, please specify age and sex
Has the animal lived with animals other than cats and dogs? *
Is the animal used to men and women? *
If so, please specify the species
What is the animal's reaction if you approach it when it is feeding? *
Please describe your animal's feeding regime - brands of food, scraps, dry or tinned, flavours, feeding times and quantities. Any dislikes? *
What commands does your animal obey? And what commands are used? For example, sit or sit down; lie or lie down etc. *
Has your pet been diagnosed with any type of illness and/or injury? *
If you answered yes to previous question, please list diagnosis and/or all medication prescribed for pet
Has your pet bitten any person with the last 14 days? *
Has your pet bitten any other animal with the last 14 days? *
If you answered yes to either of the 2 previous questions, please describe the incident
I acknowledge my understanding of, and agreement with the following terms and conditions that govern the relinquishment of the above described pet
If the animal is of suitable health and temperament, it will be placed in the Humane Society's adoption program: *
The Kodiak Animal Shelter is a "no kill" shelter for "friendly, adoptable animals. If this animal does not pass the health and/or behavioral screening at any time during the pet's stay, we may have to euthanize. This means that the animal will be put to death in the most humane way possible. It is extremely rare that we have to euthanize a pet, but in extreme circumstances the health and quality of life of the pet is taken seriously: *
I understand that I can contact the Kodiak Animal Shelter at any time to check the status of the pet that is being surrendered. I also understand that it is my responsibility to update my contact information with the Kodiak Animal Shelter.
I herby release the Humane Society of Kodiak and its employees, staff, agents and/or representatives from any claims or demands that I have, or my have, that (a) may be connected with the above described pet; (b) may arise out of the Humane Society's care of the above described pet; or (c) may arise out of the Humane Society euthanizing this pet.
Signature *
Date *

An email confirmation has been sent to the email provided on your surrender form. Please check your spam folder if it does not arrive in your inbox.

Humane Society of Kodiak Dog Surrender Profile & Release Form

Owner Information

Pet Information

I acknowledge my understanding of, and agreement with the following terms and conditions that govern the relinquishment of the above described pet

I understand that I can contact the Kodiak Animal Shelter at any time to check the status of the pet that is being surrendered. I also understand that it is my responsibility to update my contact information with the Kodiak Animal Shelter.