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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

* GenderMaleFemale

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Dog's Details

Adopted pet's current name:

Adopted pet's name at time of adoption:

Did you adopt your pet from MatchDog?

YesNo

Pet's Microchip ID

Breed:

If you did not adopt your pet from MatchDog Please describe the name and address of the individual or organization where you acquired your pet. Please include as many details as possible including. If your dog was a MatchDog please state so in this block in order to proceed.

Dog's color:

Dog's Sex

MaleFemale

Dog's weight:

Dog's age:

Date of adoption:

Is your dog up to date of rabies, parvo//distemper, and bordatella vaccinations?

Please be prepared to show vet records

YesNo

Is your dog up to date on monthly heartworm prevention?

YesNo

Date last heartworm preventative was given:

Is your dog up to date on flea and tick prevention?

YesNo

Date last flea/tick preventative was given:

Is your pet spayed or neutered?

YesNo

Please provide the name and phone number of your dog's veterinarian:

Does your dog have any medical or behavioral issues? If so, please explain:

If you have provided professional training for this dog, please provide name and phone number of the trainer

Has this dog ever bit a person or another pet? If so, please explain:

Please tell us why you are giving up this dog. Please be honest as this will help us understand why this dog is not working out in it's current home and how we can replace the pet in a more appropriate home:

Please tell us about your dog's personality, likes/dislikes, quirks, etc. The more information we have for a bio, the faster we can find an adopter and rehome him/her.

Please attach all vet records you have for this dog:

Please attach pictures of the dog you are surrendering:

How long ago did you adopt your pet?

Is your dog house trained?

YesNo

Is your dog crate trained?

YesNo

What commands does your dog know?

What is your dog's energy level?

Does your dog like children? If it depends on age please be specific.

Is your dog destructive to furniture or belongings? If so, when does the destructive behavior occur?

Would you describe your dog as submissive or dominant?

SubmissiveDominant

Does your dog get along with other dogs and cats?

Gets along with dogs onlyGets along with cats onlyGets along with both dogs and catsDoes not get along with dogs or cats

Is your dog food aggressive?

Describe the circumstances

How does your dog react to visitors in your home?

How does your dog react to people he/she lives with?

Please tell us about your dog's personality, likes, dislikes, quirks, triggers, etc. The more info we have the faster we will be able to place them.

If you were not able to attach to this form, please attach all vet records and photos to an email and send to mdr.applications@gmail.com

Do you understand by submitting this form you are surrendering the dog specified to MatchDog Rescue. You are no longer the owner of this dog and are acting as a foster parent until MatchDog Rescue can get this dog adopted or placed in another fosters home.

Yes, I understand

DISCLAIMER: Once you have completed this surrender form in full and have submitted it along with updated pictures and proof of updated medical records, MatchDog Rescue will require you to keep this dog in your home and under your care until we find them a new home. We will work hard at placing your pet in their new home once you have submitted the required information. By submitting this form you are waiving your rights pertaining to the placement processes or the decisions involved in placing your dog in a new home MatchDog Rescue ; these decisions are the exclusive right of MatchDog Rescue. By signing below you also acknowledge that MatchDog Rescue will not share any details with respect to the new owners once your dog is rehomed. You further acknowledge and agree that you will take no deliberate action, whether by yourself or by proxy, to discover or contact the new owner.

Do you understand and agree to the above disclaimer?

YesNo

Your typed signature below represents that you are entering into a legal and binding contract with MatchDog Rescue.

Please type your full name and today's date

Sometimes, no matter how hard you try, you need to find a new home for your pet. MDR understands this and will do what we can to assist. MatchDogs are welcomed back for an assessment of adoption suitability. To begin the process send an email to mdr.applications@gmail.com. Once our volunteer reviews your email you will be sent a link to complete a surrender form. Please complete the entire form as it will help us determine if your pet is eligible for our adoption program. If your pet is eligible you may be asked to bring the dog to meet one of our volunteer behaviorists for an evaluation. We’ll assess your pet for medical and behavioral issues; many are considered treatable and will not exclude the dog from participation in our adoption program. As we are foster-based we do not euthanize for space or length of stay, but we’re not a sanctuary. There may be behavioral and medical issues that we cannot address. If we determine your pet is not a candidate for adoption or rescue we will notify you of the reason, usually within 48 hours. If we cannot accept your pet, we’ll do our best to provide you with resources, including referrals to animal behaviorists and education materials regarding behavioral issues. If we do re-home your pet the new owner’s contact information is confidential, and will not be released to you. If your dog is accepted for re-adoption you will act as the foster for the dog until we find them a suitable home. As a foster you will be responsible for bringing the dog to our Saturday events and agree to work with our Matchmaker through the week for weekday meets with potential adopters. Our Matchmakers are extremely good at what they do. Assuming you provide accurate, complete, and timely information and records and fabulous photos, and you attend the Saturday meets, your dog will be rehomed very quickly. Many unwanted animal behaviors can be corrected, enabling pets to successfully remain in the family. If you would like more information about training or other solutions for keeping your pet, please contact us. Every member of your family should be included in the decision to surrender a pet before contacting MDR. We also ask that all current veterinary health or vaccination records be brought in with the dog. The owner surrendering the dog must be at least 18 years of age and provide photo identification. As a nonprofit dependent on community contributions, we appreciate any donations to defray our costs.

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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MatchDog Surrender Form

Personal Information

Dog's Details