Owner Surrender

Our Owner Surrender Form is designed to make the process of surrendering a dog to our rescue as smooth and compassionate as possible. If you're facing a difficult situation where you can no longer care for your dog, this form helps us gather important details about your pet’s health, behavior, and history. By providing us with information about your dog's personality, medical needs, and any other relevant factors, you help us ensure they are placed in the best possible environment moving forward. Our goal is to provide every dog with a loving and safe future, and this form is the first step in that journey. Rest assured, your dog’s well-being will remain our top priority as we work to find them a forever home.

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Is your dog up-to-date on DHLPP vaccination?

Is your dog up-to-date on Bordetella vaccination?

Does your dog receive heartworm preventatives?

Does your dog receive flea and tick control?

Veterinarian/Practice Name:

Veterinarian's Phone:

Dog Name:

Is your dog male or female?:

Is your dog spayed or neutered?:

Please provide your dog's birth date. If you cannot provide that, please tell us the age of your dog.:

How much does your dog weigh?:

What breed is your dog?:

Where did you get your dog?:

When did you get your dog?:

Has your dog ever injured another person? If so, please describe the circumstances:

Has your dog ever injured another animal? If yes, please describe.:

Does your dog have any injuries or illnesses? Please describe.:

Please describe your dog’s personality and traits. (ex.Friendly, Agressive, crate trained, house trained)

Why are you surrendering your dog?:

Anything additional we should know about your dog?:

By checking this box, I acknowledge that I have read and answered each question on this Owner Surrender Form and have provided truthful answers. I am providing consent to SSR to contact my Veterinarian for further information if needed.

Full Name

Date

Month

Day

Year

Signature