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Dog Surrender Form

Phone Number

Where did you receive your dog?

Adopted from a shelter or rescue

Purchased or received the pet as a puppy

Received from a friend or family member

What shelter or rescue did you adopt your pet from?

When did you receive your dog?

What is your reason for rehoming your dog?

If we provide you with a solution for keeping your pet, would you consider keeping it?

Yes

Pet Information

Dog Name

What is your dog's age?

How many pounds does your dog weigh?

What is the gender of your dog?

Male

Female

Is your dog spayed or neutered?

Yes

When was your dog spayed or neutered?

How long has this dog lived with you?

Is your dog good with children?

Yes

Please tell us about the age of the children your dog has interacted with and how they play together. Does the dog understand the size/strength differences?

Is your dog good with strangers?

Yes

Describe how your dog behaves when seeing a stranger walk down the street or enter your home.

If your dog is not good with strangers, what does your dog do?

Has your dog snapped at anyone?

Yes

Has your dog bitten anyone?

Yes

Please describe the circumstances and the extent of the injury.

Is your dog good with cats?

Yes

Has your dog ever injured or killed another cat?

Yes

Please describe any aggressive behavior exhibited towards cats.

Is your dog good with other dogs?

Yes

Has your dog ever injured or killed another dog?

Yes

Please describe any aggressive behavior towards dogs.

Please share details about the relationship your dog has with other dogs. Please include the sizes, age and sexes of the other dogs.

Please upload a picture of your dog.

Click Here to Upload

Please provide 5-10 sentences about your dog that reflect positive qualities or any info you would like a new owner to know. Potential adopters want to know of your dog is house and/or crate-trained, if it can walk on a leash, and knows commands and/or tricks.

By signing below, I acknowledge that I have reviewed and understand the terms and conditions outlined on the Surrendering Your Pet to the Shelter page.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.