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Surrender a Dog
1
Current Owner Information
2
Dog Basics
3
Routine
4
Disposition
5
Medical
6
Authorization
First Name
*
Last Name
*
eMail Address
eMail Address
Confirm eMail Address
Street Address
*
Suite or Unit Number
City
*
State
*
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Phone
*
History
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Dog Default Status: Submitted
-- select a Status --
Available
Recovery Room
Forever Foster
Happy Tails
Left Rescue
Over The Bridge
Submitted
Surrendered
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Are you the legal owner of the dog?
*
Yes
No
Please Explain
*
Are you the only owner of the dog?
*
Yes
No
Please Provide Other Owner's Name:
Other Owner's Phone #
When Did You Get The Dog? (approximate if necessary)
Month
Day
Year
How Long Have You Had This Dog?
Select Length of Time
Under A Year
1
2
3
4
5
6
7
8
9
10+
How Was The Dog Obtained?
Select Method
Puppy of Current Dog
Shelter
Stray
Private Home
Breeder
Other
Please Explain
Breeder's Name (if Known)
Have They Been Notified?
Yes
No
Why Not?
Owner of Dog's Sire (If Known)
Why Are You Giving Up The Dog?
*
Select All That Apply
New Baby
Not Home Enough/Not Enough Time
Found As A Stray
Owner's Health Issues
Dog's Health Issues
New Home
Allergies
Moving & Cannot Take Dog
Behavior Issues
Cannot Afford Care
Other
Please Explain
Please Explain The Behavior Issues
Please Explain The Health Issues
Please Explain Care Needed
How Many Homes Has This Dog Had?
Select Number
1
2
3
4
5+
Veterinarian Information
Do You Have a Veterinarian?
Yes
No
Name of Clinic
Name of Vet
Street Address
Suite or Unit Number
City
State
Select State
Alabama
Alaska
Arizona
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California
Colorado
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District of Columbia
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Virginia
Washington
West Virginia
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Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
ZIP
Phone
Dog's Name
*
Dog's Registered Name (If Purebred)
Dog's Registration Number (If Known)
Primary Breed
*
Select Breed
Mix - Small
Basenji
Bulldog
Chinook
Dalmatian
Havanese
Hound - English Foxhound
Hound - Plott Hound
Kishu
Mastiff - Bull
Pinscher - Doberman
Presa Canario
Retriever - Yellow Labrador
Shar-Pei
Shepherd - Belgian Malinois
Spaniel – American Cocker
Spitz - Large
Terrier - Boston
Terrier - Norwich
Terrier - Wire Fox
Mix
Beagle
Bulldog - American
Chow Chow
Dogo Argentino
Havapoo
Hound - Finnish Lapphund
Hound - Redbone Coonhound
Klee Kai
Mastiff - English
Pinscher - German
Pequeno
Rhodesian Ridgeback
Sheepadoodle
Shepherd - Belgian Tervuren
Spaniel - American Water
Spitz - Medium
Terrier - Border
Terrier - Parson Russell
Terrier - Wirehaired
Mutt
Beauceron
Bulldog - English
Cirneco dell’Etna
Dogue de Bordeaux
Havashire
Hound - Foxhound
Hound - Redtick Coonhound
Komondor
Mastiff - Neapolitan
Pinscher - Miniature
Portuguese Water Dog
Rottweiler
Sheepdog
Shepherd - Dutch
Spaniel - Boykin
Spitz - Small
Terrier - Bull
Terrier - Patterdale / Fell
Terrier - Yorkshire (Yorkie)
Dad Is the Milkman
Bergamasco
Bulldog - French
Cockapoo
Entlebucher Mountain Dog
Havatzu
Hound - Galgo Spanish Greyhound
Hound - Saluki
Kuvasz
Mastiff - Tibetan
Portuguese Podengo
Pug
Saint Bernard
Sheepdog - Belgian
Shepherd - English
Spaniel - Brittany
Spitz - Eskimo
Terrier - Cairn
Terrier - Rat
Thai Ridgeback
Heinz 57
Bernadoodle
Canaan
Collie
Eskimo Dog
Havawart
Hound - Greyhound
Hound - Russian Wolfhound
Kyi Leo
Mountain Cur
Pointer
Puggle
Samoyed
Sheepdog - Caucasian (Ovtcharka)
Shepherd - German
Spaniel - Cavalier King Charles
Spitz - Finnish
Terrier - Cesky
Terrier - Scottish
Tosa Inu
Akbash
Bernese Mountain Dog
Cane Corso
Collie - Bearded
Feist
Hound
Hound - Halden (Haldenstrover)
Hound - Schiller Wolfhound
Labradoodle
Mountain Dog
Pointer - English
Puli
Sarplaninac
Sheepdog - Icelandic
Shepherd - McNab
Spaniel - Clumber
Spitz - German
Terrier - Dandie Dinmont
Terrier - Sealyham
Tennessee Treeing Brindle
Akita Inu
Bichon Frisé
Carolina Dog
Collie - Border
Fila Brasileiro
Hound - Afghan Hound
Hound - Hamiltonstovare
Hound - Scottish Deerhound
Lancashire Heeler
Munsterlander
Pointer - German Shorthaired
Pumi
Schipperke
Sheepdog - Illyrian
Shepherd - Pyrenean
Spaniel – English Cocker
Terrier - Medium
Terrier - Fox
Terrier - Smooth Fox
Vizsla
Alaskan Malamute
Black Mouth Cur
Catahoula Leopard Dog
Collie - Rough
French Bordeaux
Hound - American Coonhound
Hound - Ibizan
Hound - Swedish Vallhund
Leonberger
Native Amer Indian Dog (NAID)
Pointer - German Wirehaired
Retriever
Schnauzer
Sheepdog - Maremma
Shepherd - Romanian Mioritic
Spaniel - English Toy
Terrier - Small
Terrier - Glen of Imaal
Terrier - Silky
Weimaraner
American Blue Heeler
Blue Lacy
Cattle Dog
Collie - Smooth
Goldendoodle
Hound - American Foxhound
Hound - Irish Wolfhound
Hound - Treeing Walker Coonhound
Lhasa Apso
New Guinea Singing Dog
Pointer - Wirehaired Pointing Griffon
Retriever - Black Labrador
Schnauzer - Giant
Sheepdog - Old English
Shepherd - White German
Spaniel - Field
Terrier - Airedale
Terrier - Irish
Terrier - Skye
Whippet
American Eskimo
Boerboel
Cavachon
Corgi
Great Dane
Hound - Basset Hound
Hound - Italian Greyhound
Husky
Lowchen
Newfoundland
Pomeranian
Retriever - Chesapeake Bay
Schnauzer - Miniature
Sheepdog - Polish Lowland
Shiba Inu
Spaniel - Irish Water
Terrier - American Hairless
Terrier - Jack Russell
Terrier - Staffordshire Bull
Yorkiepoo
Appenzell Mountain Dog
Borzoi
Cavapoo
Corgi - Cardigan Welsh
Great Pyrenees
Hound - Black and Tan Coonhound
Hound - Keeshond
Husky - Siberian
Malshi
Papillon
Pomsky
Retriever - Chocolate Labrador
Schnauzer - Standard
Sheepdog - South Russian Ovtcharka
Shihpoo
Spaniel - English Springer
Terrier - American Pit Bull
Terrier - Kerry Blue
Terrier - Tibetan
Xoloitzcuintli
Ausiedoodle
Bolognese
Cheweenie
Corgi - Pembroke Welsh
Greater Swiss Mountain Dog
Hound - Bloodhound
Hound - Norwegian Buhund
Spinone Italiano
Maltese
Pekingese
Poodle
Retriever - Curly-Coated
Schnoodle
Sheepdog - Shetland
Shih Tzu
Spaniel - Springer
Terrier - American Staffordshire
Terrier - Lakeland
Terrier - Toy Fox
Ausiepoo
Bouvier des Flandres
Chihuahua
Coton de Tulear
Harrier
Hound - Bluetick Coonhound
Hound - Norwegian Elkhound
Japanese Chin
Maltipom
Peruvian Inca Orchid
Poodle - Miniature
Retriever - Flat Coated
Setter
Shepherd
Shollie
Spaniel - Sussex
Terrier - Australian
Terrier - Lurcher
Terrier - Toy Manchester
No Preference
Australian Cattle
Boxer
Chinese Crested
Dachshund
Havachon
Hound - Coonhound
Hound - Norwegian Lundehund
Jindo
Maltipoo
Petit Basset Griffon Vendéen
Poodle - Standard
Retriever - Golden
Setter - English
Shepherd - Anatolian Dog
Shorkie
Spaniel - Welsh Springer
Terrier - Bedlington
Terrier - Manchester
Terrier - Welsh
Mix - Large
Australian Kelpie
Briard
Chinese Shar-Pei
Dachshund - Miniature
Havamalt
Hound - Deerhound
Hound - Otterhound
Kai Dog
Morkie
Pinscher
Poodle - Teacup
Retriever - Labrador
Setter - Gordon
Shepherd - Australian
Sloughi
Spaniel - Tibetan
Terrier - Biewer
Terrier - Miniature Bull
Terrier - West Highland White (Westie)
Mix - Medium
Azawakh
Brussels Griffon
Chinese Foo Dog
Dachshund - Wirehaired
Havana Silk Dog
Hound - English Coonhound
Hound - Pharaoh Hound
Karelian Bear Dog
Mastiff
Pinscher - Affenpinscher
Poodle – Toy
Retriever - Nova Scotia Duck Tolling
Setter - Irish
Shepherd - Belgian Laekenois
Spaniel
Spanish Water Dog
Terrier - Black Russian
Terrier - Norfolk
Terrier - Soft Coated Wheaten
Breed Name
Secondary Breed
Select Breed
Mix - Small
Basenji
Bulldog
Chinook
Dalmatian
Havanese
Hound - English Foxhound
Hound - Plott Hound
Kishu
Mastiff - Bull
Pinscher - Doberman
Presa Canario
Retriever - Yellow Labrador
Shar-Pei
Shepherd - Belgian Malinois
Spaniel – American Cocker
Spitz - Large
Terrier - Boston
Terrier - Norwich
Terrier - Wire Fox
Mix
Beagle
Bulldog - American
Chow Chow
Dogo Argentino
Havapoo
Hound - Finnish Lapphund
Hound - Redbone Coonhound
Klee Kai
Mastiff - English
Pinscher - German
Pequeno
Rhodesian Ridgeback
Sheepadoodle
Shepherd - Belgian Tervuren
Spaniel - American Water
Spitz - Medium
Terrier - Border
Terrier - Parson Russell
Terrier - Wirehaired
Mutt
Beauceron
Bulldog - English
Cirneco dell’Etna
Dogue de Bordeaux
Havashire
Hound - Foxhound
Hound - Redtick Coonhound
Komondor
Mastiff - Neapolitan
Pinscher - Miniature
Portuguese Water Dog
Rottweiler
Sheepdog
Shepherd - Dutch
Spaniel - Boykin
Spitz - Small
Terrier - Bull
Terrier - Patterdale / Fell
Terrier - Yorkshire (Yorkie)
Dad Is the Milkman
Bergamasco
Bulldog - French
Cockapoo
Entlebucher Mountain Dog
Havatzu
Hound - Galgo Spanish Greyhound
Hound - Saluki
Kuvasz
Mastiff - Tibetan
Portuguese Podengo
Pug
Saint Bernard
Sheepdog - Belgian
Shepherd - English
Spaniel - Brittany
Spitz - Eskimo
Terrier - Cairn
Terrier - Rat
Thai Ridgeback
Heinz 57
Bernadoodle
Canaan
Collie
Eskimo Dog
Havawart
Hound - Greyhound
Hound - Russian Wolfhound
Kyi Leo
Mountain Cur
Pointer
Puggle
Samoyed
Sheepdog - Caucasian (Ovtcharka)
Shepherd - German
Spaniel - Cavalier King Charles
Spitz - Finnish
Terrier - Cesky
Terrier - Scottish
Tosa Inu
Akbash
Bernese Mountain Dog
Cane Corso
Collie - Bearded
Feist
Hound
Hound - Halden (Haldenstrover)
Hound - Schiller Wolfhound
Labradoodle
Mountain Dog
Pointer - English
Puli
Sarplaninac
Sheepdog - Icelandic
Shepherd - McNab
Spaniel - Clumber
Spitz - German
Terrier - Dandie Dinmont
Terrier - Sealyham
Tennessee Treeing Brindle
Akita Inu
Bichon Frisé
Carolina Dog
Collie - Border
Fila Brasileiro
Hound - Afghan Hound
Hound - Hamiltonstovare
Hound - Scottish Deerhound
Lancashire Heeler
Munsterlander
Pointer - German Shorthaired
Pumi
Schipperke
Sheepdog - Illyrian
Shepherd - Pyrenean
Spaniel – English Cocker
Terrier - Medium
Terrier - Fox
Terrier - Smooth Fox
Vizsla
Alaskan Malamute
Black Mouth Cur
Catahoula Leopard Dog
Collie - Rough
French Bordeaux
Hound - American Coonhound
Hound - Ibizan
Hound - Swedish Vallhund
Leonberger
Native Amer Indian Dog (NAID)
Pointer - German Wirehaired
Retriever
Schnauzer
Sheepdog - Maremma
Shepherd - Romanian Mioritic
Spaniel - English Toy
Terrier - Small
Terrier - Glen of Imaal
Terrier - Silky
Weimaraner
American Blue Heeler
Blue Lacy
Cattle Dog
Collie - Smooth
Goldendoodle
Hound - American Foxhound
Hound - Irish Wolfhound
Hound - Treeing Walker Coonhound
Lhasa Apso
New Guinea Singing Dog
Pointer - Wirehaired Pointing Griffon
Retriever - Black Labrador
Schnauzer - Giant
Sheepdog - Old English
Shepherd - White German
Spaniel - Field
Terrier - Airedale
Terrier - Irish
Terrier - Skye
Whippet
American Eskimo
Boerboel
Cavachon
Corgi
Great Dane
Hound - Basset Hound
Hound - Italian Greyhound
Husky
Lowchen
Newfoundland
Pomeranian
Retriever - Chesapeake Bay
Schnauzer - Miniature
Sheepdog - Polish Lowland
Shiba Inu
Spaniel - Irish Water
Terrier - American Hairless
Terrier - Jack Russell
Terrier - Staffordshire Bull
Yorkiepoo
Appenzell Mountain Dog
Borzoi
Cavapoo
Corgi - Cardigan Welsh
Great Pyrenees
Hound - Black and Tan Coonhound
Hound - Keeshond
Husky - Siberian
Malshi
Papillon
Pomsky
Retriever - Chocolate Labrador
Schnauzer - Standard
Sheepdog - South Russian Ovtcharka
Shihpoo
Spaniel - English Springer
Terrier - American Pit Bull
Terrier - Kerry Blue
Terrier - Tibetan
Xoloitzcuintli
Ausiedoodle
Bolognese
Cheweenie
Corgi - Pembroke Welsh
Greater Swiss Mountain Dog
Hound - Bloodhound
Hound - Norwegian Buhund
Spinone Italiano
Maltese
Pekingese
Poodle
Retriever - Curly-Coated
Schnoodle
Sheepdog - Shetland
Shih Tzu
Spaniel - Springer
Terrier - American Staffordshire
Terrier - Lakeland
Terrier - Toy Fox
Ausiepoo
Bouvier des Flandres
Chihuahua
Coton de Tulear
Harrier
Hound - Bluetick Coonhound
Hound - Norwegian Elkhound
Japanese Chin
Maltipom
Peruvian Inca Orchid
Poodle - Miniature
Retriever - Flat Coated
Setter
Shepherd
Shollie
Spaniel - Sussex
Terrier - Australian
Terrier - Lurcher
Terrier - Toy Manchester
No Preference
Australian Cattle
Boxer
Chinese Crested
Dachshund
Havachon
Hound - Coonhound
Hound - Norwegian Lundehund
Jindo
Maltipoo
Petit Basset Griffon Vendéen
Poodle - Standard
Retriever - Golden
Setter - English
Shepherd - Anatolian Dog
Shorkie
Spaniel - Welsh Springer
Terrier - Bedlington
Terrier - Manchester
Terrier - Welsh
Mix - Large
Australian Kelpie
Briard
Chinese Shar-Pei
Dachshund - Miniature
Havamalt
Hound - Deerhound
Hound - Otterhound
Kai Dog
Morkie
Pinscher
Poodle - Teacup
Retriever - Labrador
Setter - Gordon
Shepherd - Australian
Sloughi
Spaniel - Tibetan
Terrier - Biewer
Terrier - Miniature Bull
Terrier - West Highland White (Westie)
Mix - Medium
Azawakh
Brussels Griffon
Chinese Foo Dog
Dachshund - Wirehaired
Havana Silk Dog
Hound - English Coonhound
Hound - Pharaoh Hound
Karelian Bear Dog
Mastiff
Pinscher - Affenpinscher
Poodle – Toy
Retriever - Nova Scotia Duck Tolling
Setter - Irish
Shepherd - Belgian Laekenois
Spaniel
Spanish Water Dog
Terrier - Black Russian
Terrier - Norfolk
Terrier - Soft Coated Wheaten
Breed Name
Primary Color
Select Color
No Preference
Black
Blue
Brown
Chocolate
Cream
Fawn
Grey
Gold
Liver
Red
Ruby
White
Yellow
Black and Tan
Black and White
Blenheim
Blue and Tan
Brindle
Flecked Ticked or Spotted
Harlequin
Hairless
Liver and Tan
Merle
Particolor
Roan
Sable
Saddle or BlanketSpotted
Saddle or Blanket
Tri Color
Tuxedo
Which Color?
*
Secondary Color
Select Color
No Preference
Black
Blue
Brown
Chocolate
Cream
Fawn
Grey
Gold
Liver
Red
Ruby
White
Yellow
Black and Tan
Black and White
Blenheim
Blue and Tan
Brindle
Flecked Ticked or Spotted
Harlequin
Hairless
Liver and Tan
Merle
Particolor
Roan
Sable
Saddle or BlanketSpotted
Saddle or Blanket
Tri Color
Tuxedo
Which Color?
*
Gender
*
Male
Female
Dog's Date of Birth (If Known)
Month
Day
Year
Weight
Select Weight
1 Pound
2 Pounds
3 Pounds
4 Pounds
5 Pounds
6 Pounds
7 Pounds
8 Pounds
9 Pounds
10 - 20 Pounds
21 - 30 Pounds
31 - 40 Pounds
41 - 50 Pounds
51 - 60 Pounds
61 - 70 Pounds
71 - 80 Pounds
81 - 90 Pounds
91 - 100 Pounds
Over 100 Pounds
Energy Level
*
Select Energy Level
High Energy
Affectionate
Happy
Intelligent
Couch Potato
Active and Playful
Gentle and Friendly
Good With Kids?
*
Select Option
I Like All Kids
I Like Kids Over 6
I Like Kids Over 10
I Don't Like Kids
I Have Not Been Tested with Kids
Good With Dogs?
*
Select Option
I Like All Dogs
I Only Like Small Dogs
I Only Like Big Dogs
I Like Select Dogs
I Don't Like Dogs
I Have Not Been Tested with Dogs
Please Explain
*
Good With Cats?
*
Select Option
I Like All Cats
I Like Some Cats
I Don't Like Cats
I Have Not Been Tested with Cats
Good With Small Animals?
Select Option
I Like All Small Animals
I Like Some Small Animals
I Don't Like Small Animals
I Have Not Been Tested with Small Animals
Good With Livestock?
Select Option
I Am Good with Livestock
I Am Scared of Livestock
I Am Aggressive with Livestock
I Have Not Been Tested with Livestock
Is Dog Trained?
Select Option
I'm Trained
I'm Currently In Training
I'm Not Trained Yet
Are There Any Special Needs?
Yes
No
What Special Needs?
Blind
Deaf
Doesn't Walk Well
Medical Condition
Select All That Apply
Description of the Dog
Featured Image
Accepted file types: jpg, jpeg, png, gif.
750 Wide x 750 High in Pixels
Additional Photos of The Dog
Drop files here or
Select files
Accepted file types: jpg, gif, png, jpeg, Max. file size: 1 MB, Max. files: 3.
Upload Photos of the Dog (minimum of 3 - include one head shot, one full body) and 750 Wide x 750 High in Pixels
Eating
How Often Is The Dog Fed?
Select Option
Once (Morning)
Once (Afternoon)
Once (Evening)
Twice (Morning & Evening)
Does Dog Eat Wet Or Dry Food (Or Both)?
Select Option
Wet
Dry
Both
What Type Of Wet Food Does The Dog Eat?
*
How Much Wet Food Does The Dog Eat?
*
What Type Of Dry Food Does The Dog Eat?
*
How Much Dry Food Does The Dog Eat?
*
What Type Of Wet Food Does The Dog Eat?
*
How Much Wet Food Does The Dog Eat?
*
What Type Of Dry Food Does The Dog Eat?
*
How Much Dry Food Does The Dog Eat?
*
Is Dog A Good Eater?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Steal Food From Table/Counters?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Sleeping
Which Room Does Dog Normally Sleep In At Night?
Any Room He/She Wants
In Adult's Room
In Kid's Room
Family/Living Room or Den
Garage
Outside
Other
Select All That Apply
Please Describe
*
What Does Dog Use For A Bed?
Crate
Dog Bed
Human Bed
Sofa/Chair/Furniture
Other
Select All That Apply
Please Describe
*
Is Dog Allowed On Furniture?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Grooming
How Often is Dog Bathed?
Select Option
Weekly
Every Other Week
Monthly
Does Dog Mind Baths/Grooming
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Mind Toenails Clipped
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Mind Ears Cleaned
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Dog & People
Is Dog A One Person Dog?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Like Men?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Explain
*
Please Explain
*
Does Dog Like Women?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Explain
*
Please Explain
*
Does Dog Prefer Men?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Explain
*
Does Dog Prefer Women?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Explain
*
Does Dog Jump On People?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Is Dog Friendly With Strangers?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Is Dog Good With Other Animals?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Is Dog Good With Kids?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Like Kids Under 6?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Like Kids 6-10?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Like Kids Over 10?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Dog's Temperament
Friendly
Playful
Dominant
Fearful
Shy
Mellow
Active
Aggressive
Select All That Apply
How Are Dog's Social Skills?
Plays with Dogs
Has Selective Dog Friends
Plays at Doggie Daycare
Plays at Dog Beach
Select All That Apply
Training
Does Dog Know Basic Commands?
Sit
Stay
Down
Off
Heel
Come
Leave It
All Of The Above
None Of The Above
Select All That Apply
Is Dog Obedience Trained?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Is Dog House Trained?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Is Dog Crate Trained?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Is Dog Leash Trained?
Select Option
Yes
No
In Training
Not Tested/Not Sure
How Does Dog React on Walks?
Well Mannered
Pulls on Leash
Likes Other Dogs
Happy to See People (Strangers)
OK with Distractions (Bikes, Skateboards)
Doesn't Likes Other Dogs
Lunges at Other Dogs
Isn't Happy to See People (Strangers)
Doesn't Like Distractions (Bikes, Skateboards)
Drags Walker
Select All That Apply
Does Dog Know How To Use A Doggie Door?
Select Option
Yes
No
In Training
Not Tested/Not Sure
Does Dog Have Occasional Accidents?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Tear/Chew Furniture Or Carpet?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Can Dog Be Left Uncrated?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Dig?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Know How To Swim?
Select Option
Yes, Loves It
Yes, Doesn't Like It
Some Or Sometimes
Not Tested/Not Sure
No
Does Dog Jump Fences?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Escape?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Ride Well In The Car?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Barking
Does Dog Bark At Noises?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Bark At Someone At The Door?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Does Dog Bark Excessively?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Fear & Agression
Does Dog Exhibit Submissive Behavior?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Describe
*
Please Describe
*
Does Dog Exhibit Aggressive Behavior?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Describe
*
Please Describe
*
Does Dog Guard Food?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Describe
*
Please Describe
*
Does Dog Guard Other Resources (Toys, People, etc.)?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Describe
*
Please Describe
*
Is Dog Shy?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Describe
*
Please Describe
*
Is Dog Fearful Of Strange Noises/Storms?
Select Option
Yes
No
Some Or Sometimes
Not Tested/Not Sure
Please Describe
*
Please Describe
*
Has Dog Ever Bitten Anyone?
Select Option
Yes
No
Unknown
Please Explain
*
Has Dog Otherwise Attacked Anyone?
Select Option
Yes
No
Unknown
Please Explain
*
Has Dog Attacked Another Animal (Dog, Cat or Other)?
Select Option
Yes
No
Unknown
Please Explain
*
Is there anything else you would like to let us know about the dog's disposition?
Medical: MicroChip Information
Is Dog MicroChipped
Select Option
Yes
No
Unknown
Are you prepared to transfer registration to {RescueName} on or prior to the surrender of the dog?
Yes
No
MicroChip Company (If Known)?
Select Company
24Pet Watch
AKC
AVID
Found Animals
Home Again
Nano
Pet Link
Smart Tase
Other
Other Company
MicroChip Number (If Known)?
Does Dog Have a Tattoo?
Select Option
Yes
No
Unknown
Please Upload Photo
*
Drop files here or
Select files
Accepted file types: jpg, gif, png, jpeg, Max. file size: 5 MB, Max. files: 3.
Please Describe
*
Medical: Medical Conditions
Add Current Medical Conditions (N Number)
Add Past Medical Conditions (N Number)
Medical: Status
Is Dog Spayed Or Neutered?
Yes
No
Date:
*
Month
Day
Year
Expected Date
*
Month
Day
Year
Please Explain Why Not
*
Medical: Dental Conditions
Add Current Dental Conditions (N Number)
Add Past Dental Conditions (N Number)
Medical: Known Allergies
Add Allergies (N Number)
Medical: Medicines
Add Medications (N Number)
Notes
Is there anything else you would like to let us know?
In your opinion, what would be the best type of home situation for this dog?
Authorization: I hereby represent and warrant each of the following: (a) that I am the rightful owner/keeper/caretaker/custodian of the dog (b) that I have authority to convey, surrender and relinquish the dog, (c) that I am hereby willfully surrendering and releasing any and all of my property rights to the dog, (d) that no other person has a right of ownership or property to the dog, (e) that upon surrender the dog may not be returned to me. I have read and understand the terms of this Surrender From.
*
Yes
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