Owned Dog Surrender Form

**You must complete every part of the surrender form for us to consider taking in your animal for surrender. This includes sending a photo of the animal that you want to surrender. Photos help us determine size and age of the animal and that helps us better determine if we have space for the animal. Many people don't know or are wrong on the size, age, breed of an animal and this can change whether we can or cannot take them in at that time. *

Today's Date *

Dog's Name that you wish to rehome (please fill out one surrender form per dog) *

Your First Name *

Your Last Name *

Your address. Please include city as well. *

Your Phone number *

Your email address (you must leave a valid email address so that we can contact you) *

Why are you needing to surrender your dog? *

Is your dog male or female? *

How old is the dog you are surrendering? *

Is your dog spayed or neutered? *

What breed(s) is the dog you are surrendering? *

About how much does your dog weigh? *

How long have you owned this dog? *

Is your dog up to date on vaccines? *

If your dog has been vaccinated within the last year we will need paper proof of those vaccines before we can take the dog. If your dog hasn't been vaccinated in the past year, should we agree to take the dog you will have to have it vaccinated by us and then bring the dog back in 2 weeks so we can vaccinate it again before we take it into the shelter. This is to protect your animal coming in and those already in the shelter from potential diseases. *

Has your dog been to a vet since you've owned it? *

If your dog has been to a vet before, what is the name of that vet?

What is the vet's phone number?

If your dog has been to the vet before, how did they handle the vet visit?

Is the dog house trained? *

Has your dog lived with cats before? *

How does your dog feel about the crate? *

Is your dog good with cats? Please check all that apply. *

Has your dog lived with children before? Please check all that apply. *

Does your bark a little or a lot? *

Has your dog been good with kids? Please check all that apply *

Has your dog lived with other dogs? Please check all that apply. *

What does your dog do when meeting other dogs? Please select all that apply *

Which best describes your dog when meeting a new dog? Please select all that apply. *

Is your dog good at meeting strangers? *

What does your dog do when meeting a stranger? Please check all that apply. *

Which describes your dog best when meeting strangers? *

Do you ever worry your dog will snap or bite at a person, child, dog or cat? *

What does your dog do when they meet a child they don't know? Please select all that apply. *

Which best describes your dog when meeting a child they don't know? Please select all that apply *

What does your dog do when someone approaches them when they have a special treat or toy? Please select all that apply. *

What does your dog do when another dog approaches them when they have a special treat or toy? Please select all that apply. *

What does your dog do when a child comes near them when they have a special treat or toy? Please select all that apply. *

Please tell us anything else about your animal you would like us to know? Quirks they may have, likes and dislikes, etc. *

Has the dog ever chased or attempted to attack or bite a person? *

If you answered yes to your dog chasing or attempting to attack or bite a person please explain in detail each instance this occurred. If you answered yes to this question and do not explain it will be an automatic denial. If you answered No to the question please type N/A *

Has the dog ever bitten a person? *

If you answered yes to the question "Has the dog ever bitten a person?" You must explain each instance in detail. If you do not explain the situations it will be automatic denial *

Has the dog ever seriously injured or killed a person? *

If you answered yes to the question "Has the dog ever seriously injured or killed a person?" explain each instance in detail. If you do not answer this question it will result in automatic denial. *

Has the dog previously been designated a nuisance, dangerous, or vicious dog? *

If you answered yes to the question "Has the dog previously been designated a nuisance, dangerous, or vicious dog?" indicate the designation that was assigned, the date of the designation, and in which county or city the designation was made. If these questions are not answered in full it will be an automatic denial. *

Has your dog ever injured another animal or person before? *

If you answered yes-If so, please list each instance and the situation that occurred and how serious was the injury. *

Has the dog ever chased or attempted to attack or bite another animal? *

If you answered yes to the question "Has the dog ever chased or attempted to attack or bite another animal?" explain the instances and the species involved. If you do not answer this question it will result in automatic denial. *

Has the dog ever bitten another animal? *

If you answered yes to the question "Has the dog ever bitten another animal?" you must explain each situation and include the species they bit. If you do not answer this question it will result in automatic denial. *

Has the dog ever seriously injured or killed another animal? *

If you answered yes to the question "Has the dog ever seriously injured or killed another animal? explain each instance this has happened and include the species of animal hurt. If you do not answer this question in full it will result in automatic denial. *

Would you like to receive our newsletter and updates from us? *

What's next? The Director will review your surrender request and reply via email whether you move on to the assessment part of the process. Please be aware kennel space goes quickly. Keep an eye on your email and respond quickly as to when you can schedule a time for assessment. *

I understand that this surrender form is just the first step to the surrender process. I understand I still have to bring them in for an in-person assessment to see how the dog behaves before a final decision is made. The in-person assessment only happens when the director schedules it with you. Please watch your email. *

We understand that surrendering a pet is a difficult decision, and we’re here to help. However, as a non-profit organization that receives no government funding surrender fees are essential to keeping our doors open and continuing our mission. Each animal we take in needs and receives the following: 🔹 Medical Care 🔹 Food & Shelter 🔹 Vet Costs 🔹 Staff to care for them 🔹 Adoption Fees Don’t Cover It All By paying a surrender fee, you’re helping us provide the best possible care to every animal that comes through our doors. It ensures they’re healthy, safe, and ready for a fresh start in a loving home. Thank you for understanding and supporting our mission.

I understand there is a surrender fee of $50 should my dog pass assessment. *

If you are unable to afford the surrender fee, we do have a program where you can volunteer 5 hours of time to offset the cost of the surrender fee. Please understand that the volunteer hours will need to be completed before we can intake your dog, provided the dog has passed assessment and we have agreed to take the dog in. *

I understand that once I surrender my dog to the Humane Society, they will have the right to make decisions about my dog, such as, but not limited to, adoption, transfer to another facility, euthanasia, etc. *

After filling out this form please send photos of your dog or puppy to our email at highcohumanesociety@gmail.com. Sending photos is part of the requirements and without it we cannot move forward. *

By typing your name here, You are attesting that every answer you have given is truthful and correct. *