Dog Relinquishment Form

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Phone(Required)

Dog's Name(Required)

Breed(Required)

Age:(Required)

Gender(Required)

Spayed/Neutered?(Required)

Microchipped?(Required)

Please share the reason you're seeking to rehome your dog so we can best assist you.(Required)

Does your dog have any medical issues or diagnosis?(Required)

How does your dog behave at the veterinarian?(Required)

Does your dog need to be or has been muzzled at a veterinarian?(Required)

Please share your dog's most recent veterinary visits and the reasons for them.(Required)

Mark all that apply:(Required)

My dog has snarled (showed teeth) at me, another pet, or someone else.

My dog has snapped at me, another pet, or someone else.

My dog has growled at me, another pet, or someone else.

My dog has nipped at me, another pet, or someone else.

My dog has bitten or broken skin on me or someone else.

My dog is protective of their spot, bed, food, toys, or people he likes.

None of these apply to my dog.

*If you marked any of the above, please explain the circumstances and how often it has occurred.

Has your dog lived with another dog? How do/did they interact?(Required)

Has your dog lived with a cat? How do/did they interact?(Required)

Has your dog lived with children? How do/did they interact?(Required)

Please upload an image of your dog. (Notice: Submissions without a photo are considered incomplete and will not be accepted.)(Required)

Accepted file types: jpg, jpeg, png, gif.

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