Surrendering

Complete the form below. Please allow 72 hours to respond. We are all volunteers! Include clear and good pictures.
This Form does NOT guarantee that we can accept the dog into our facility.
We are a dog only rescue and only have limited space. You must be the LEGAL owner of the dog. Our rescue can NOT take in stray dogs.
If this is a dog you adopted from our rescue, no form is needed, immediately email us at rescuehsnwla@gmail.com
Please note that we have do not have rescue resources for pit bulls, Staffordshire Terriers or any mixes. You can search for pit bull or staffordshire terrier rescues on Facebook and petfinder and message them for assistance.

Dog Surrender Form

* Indicates required field

Date *

Name *

First

Last

Address *

Email *

Phone Number *

Dogs Name *

Where did you get the dog? *

How long have you owned the dog? *

Breed *

Date of last vet visit? *

Age *

Weight *

Gender *

Current on Vaccinations? *

Name and Number of Current Veterinarian *

Any known Medical problems *

Current on heartworm prevention? *

Microchip Number if applicable *

Housetrained? *

Any bite history? If so please explain what happened, when and if it was reported to animal control. *

Spayed/Neutered? *

Good with strangers? *

Good with dogs? *

Good with cats? *

Good with kids? *

Inside or Outside dog? *

Why are you re-homing? Any other comments or information we need to know about the dog? *

Picture of the dog *

Max file size: 20MB

Picture of the dog *

Max file size: 20MB

Submit

Dog Surrender Form

MAKE A DONATION