OWNER SURRENDER Please note that all fields are required. Please type N/A if not applicable. If you’d rather print and mail the form, click here. Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Email * What is your dog's name? * What is the breed of the dog you'd like to surrender? * What is the size of the dog? * Small Medium Large How much does the dog weigh? * How old is the dog? * What is the gender of the dog? * Female Male Why are you unable to keep the dog? Please be specific. * Is the dog spayed/neutered? * Yes No Where and when did you get the dog? * Describe the dog's temperment. * Is this dog friendly with other dogs? * yes no not sure Is this dog cat friendly? * yes no not sure Is this dog up to date on vaccinations? (Please be prepared to show proof). * yes no found - not sure Has this dog ever bitten a child or an adult? (If yes, please describe circumstances). * If this dog was found, please provide as many details as possible (location, date). * If this dog was found, what have you done to try to find owners? Rescue may not be able to take in the dog until these steps have been completed. * Checked for microchip Posted on social media Posted found signs in area where found Reported found to a shelter I have done none of these things Not applicable, not a found dog Does this dog have any medical issues? * Does this dog have any behavioral issues? * Describe the perfect home for him/her. * By signing my name, I hereby certify that I am the rightful owner of the animal who is subject of this owner surrender form. I hereby surrender any and all property rights to the animal as of today. I certify that no other person has property rights to this animal. I understand that by surrendering my rights to the animal, the animal may be transferred into the custody of another rescue. I also hereby certify that all information provided on this form is accurate. I understand that failure to disclose any information may result in the dog being returned to me/or mandatory compensation to the rescue for injury sustained and/or medical/vetting bills accrued. I understand that once I relinquish the animal, the dog will not be able to be returned. I certify that I have read and understand the terms of this Owner Surrender Form. Please sign or type your name below. * Thank you!
