Contact Information - all fields throughout the form *MUST* be completed.

Every field throughout the entire application must be completed.

• If you do not fill out the application in FULL, or are not 100% truthful, your surrender request will be discarded without further notice.  

• If a question does not apply to you, fill in the blank with "Not Applicable" or "N/A".

• Most of our volunteers and foster families work full time, have families, have pets, and a life of their own, so please be patient.  We will get back to you as soon as possible.   After you submit the surrender request, you will be directed to EMAIL A PHOTO OF YOUR DOG.   This is a requirement in order for your dog to be considered.

Your Full Name 

Email Address *REQUIRED* 

Retype Email to Confirm 

Address 

City 

State 

Zip 

Daytime Phone 

Please include area code.

Evening Phone 

Include area code.

Best Time & Place To Call 

 Information About Your Dog

Dog's Name 

Dog's Date of Birth/Age 

If unknown type in your best guess.

Gender 

   Male Female

Color 

Is this dog microchipped?  If so what brand?  Home Again? Avid?  Other?
Please specify and list Microchip or tattoo number.

Is this a purebred?   Yes No   If purebred, what breed?  (Attach photos of dog)

If this is a mix, a mix of   and  (Attach photos of dog)

Do you have a copy of your dog's vet records?   Yes No  (If we can take your dog into our program, we will need vet records)

Where did you get your dog?
(From a neighbor, friend, newspaper ad, pet store, breeder?) List Breeder Name & Phone Number if known.

All GOOD BREEDERS will always help if need to you re-home your dog.  Have you contacted the breeder?
Yes No

Is your dog spayed/neutered?    Yes No

Please list your dog's Veterinarian Name and Phone Number. (Please include area code.)

Do you have a copy of your dog's vet records?     Yes No

How long have you owned this dog? 

Why do you need to give up your dog?  Please elaborate.

Would you want to have your name and phone number released to the new adopter?     Yes No

Has this dog been an indoor dog or an outdoor dog?

Is the dog housebroken?      Yes No

How does he/she let you know he wants to go outside?

Has the dog ever been in a dog fight?  If so, please describe the circumstances.

How would you rate your pet's energy level?
Very Low  Low  Medium  High  Very High

How would you describe his/her personality?  (Check all that apply.)

Does this dog prefer men or women? Men Women  No Preference

What upsets the dog?

How does the dog act when alone?

What parts of your pet's body does he NOT like touched by visitors/guests?

What parts of your pet's body does he NOT like touched by family?

What commands or skills does your dog know?

Please Click SUBMIT only once.

The application process may take a number of days, due to the need for confirmation of the information provided..

Submission of an application does not guarantee placement of a dog.