Skip to content
865 Rescue and Rehome
Pets In Need
Adoption Application
Foster Application
Foster Information
Volunteer Application
Owner Surrender Form
About Us
Petfinder
Contact
Owner Surrender Form
← Back
Thank you for your response. ✨
Owner’s Information
Name
(required)
Email
(required)
Phone
(required)
Address with City, State and Zip Code
(required)
Date of Birth
(required)
Dog’s Information
Name of Animal
(required)
Breed
(required)
Age
(required)
Sex
(required)
Male
Female
Altered?
(required)
Spayed
Neutered
Not Altered
Unknown
Microchipped?
(required)
Yes
No
Unknown
Why are you surrendering this dog?
(required)
Where did you get this dog?
(required)
Name and Phone Number of Vets
(required)
Dog’s Information/Favorites
Food
Allergies
Toys
Car Rides
Good with dogs
Yes
No
Unknown
People
Yes
No
Unknown
Kids
Yes
No
Unkown
Cats
Yes
No
Unknown
Current Shots
Last Vet Visit
Heartworm Preventative
Flea Preventative
Last Meal/Feeding Schedule
Signature
(required)
Date (YYYY-MM-DD)
(required)
State Driver’s License Number
(required)
I hereby voluntarily relinquish all claims and ownership of said dog to the organization known as 865 Rescue and Rehome, and members thereof. I cannot reclaim this dog once the dog is in possession of 865 Rescue and Rehome, and understand that this animal will be spayed or neutered, if needed. I agree to give up the dog’s AKC registration papers and all medical records available. Neither 865 Rescue and Rehome, nor members, thereof shall be held responsible for actions of the adoptive or foster family and/or dog. I certify that this dog is not vicious and has never shown signs of aggression towards human beings.
(required)
Yes
No
Submit Form
Submitting form
Δ
