If you are in need of surrendering your dog please complete the form below. Please answer ALL questions honestly and to the best of your ability. Please disclose all medical and behavioral issues, no matter how minor. Our goal is to place your pet in the best possible home and this information is crucial in making a successful placement.

We also require any vet records and a photo(s) be included.

**Please note: we are a foster-based rescue. All dogs brought into our program are placed into foster homes. We do not have a shelter facility. We can not take every dog we receive a request for, however we do our best to place those most in need.

Date *
Date
Name *
Name
Address *
Address
Phone *
Phone
Spayed/Neutered? *
Has your dog ever bitten, snapped at, or attacked a person, dog, or cat? *
Is the dog currently living with you? *
Is the dogs Rabies vaccination current? *
Is the dog up to date on shots? *
Is the dog on monthly heartworm preventative? *
Does the dog have a regular vet? *
Is the dog housebroken? *
Is the dog crate trained? *
Is the dog leash trained? *
Is the dog a fence jumper? *
Does the dog have any destructive behavior? (chewing, digging, etc.) *
Is the dog aggressive around food? *
Is the dog aggressive around toys? *
Does the dog get along with kids? *
Does the dog get along with other dogs? *
Does the dog get along with cats? *
Does the dog have separation anxiety? *