Owner Surrender Form

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? *

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

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. *

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? *

How does your dog feel about the crate? *

Has your dog lived with cats before? *

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. *

Has your dog ever bitten anyone before? Please share each instance and the situation that occured with it and the seriousness of the injury. (Please know that if you lie about a bite you can be sued should your dog bite anyone else) *

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

Which describes your dog best when meeting strangers? *

Has your dog ever injured another animal or person before? If so, please list each instance and the situation that occurred and how serious was the injury. *

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. *

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. *

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

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. *

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