Surrender Form

To surrender a dog, please complete the following Hard Licker Ranch Surrender Form. Hard Licker Ranch will NOT consider accepting a dog until a surrender form has been completed.

IF YOU ARE SURRENDERING MULTIPLE DOGS, PLEASE COMPLETE A SURRENDER FORM FOR EACH DOG.

The surrender form allows us to have a better idea of why the dog is being surrendered, any behavior issues, health issues, etc. Hard Licker Ranch cannot consider placing a dog if we do not have a complete temperament and medical background. It is critical that you complete the application as all of our foster homes have other pets and/or children and we consider their safety first. Because surrendered dogs are placed in foster homes with other pets and/or children, we cannot accept dogs that are aggressive and/or have a bite history (provoked or not).

Completion of this form does not guarantee that Hard Licker Ranch will accept your surrendered dog. Because of foster home or fund limitations, it is sometimes necessary to place the dog on a waiting list. Upon receiving the application, we will consider your dog for our program and look for a suitable foster home; we will contact you about the status of the surrender.

Be Advised: At the time of the surrender, Hard Licker Ranch reserves the right to revoke acceptance of a due due to aggression, lack of medical records, misrepresentation, etc. Please understand that we are an all-volunteer organization and that it may take up to 48 hours to get back to you regarding your inquiry.

In addition, once we decide to take a dog in it takes time to find a foster home and arrange transport; we will not be able to drop everything and accept your dog. Typically it is not an extremely quick process so be prepared for a wait period before we can accept your dog.

Animal's name:

Breed:

Color(s):

Age:

Approximate Weight:

Is the dog spayed/neutered?

Is the dog hearing and/or vision impaired?

What is your reason for surrender?

Has this been the dog’s only home?

If no, why did the previous owners give up the dog?

Is the dog crate trained?

Does the dog potty in the crate?

Is the dog house trained?

Where is the dog normally kept?

If other arrangements when you are home, please explain:

Where is the dog kept when you are not home?

If other arrangements when you are not home, please explain:

Where does the dog sleep at night?

If other sleeping arrangements, please explain:

Is the dog allowed on furniture

What brand of food is the dog eating?

How many cups does the dog get at EACH feeding?

At what times is the dog normally fed?

Does the dog have any food/treat allergies?

If yes, please explain the food/treat allergies.

Has the dog been to any type of obedience training?

Please list all the commands/signals the dog knows.

Is the dog good with children?

If yes, please list the ages of the children the dog has been around.

Is the dog afraid of any of the following? (check all that apply)

Is the dog good with the following? (Please select all that the dog is good around/seeing on the street/yard)

Is the dog destructive?

Has the dog ever bitten or snapped at anyone?

Has the dog bitten or killed another animal? (including squirrels, rabbits, cats, dogs, chickens, etc.)

If yes, please explain.

Does the dog do any of the following? (check all that apply)

What is the dogs temperament? (check all that apply - explain selections with * below)

Please explain*

Does the dog live with other animals?

If yes, please list all other animals in the home, their sex and age:

Does the dog ride good in cars?

Does the dog like toys?

Is the dog trained to walk on a leash?

Does the dog resist grooming/nail trimming?

Is the dog accepting of strangers?

Please describe any other unusual behaviors not covered above:

Does the dog have a current Veterinarian/Clinic?

Current Veterinarian/Clinic

Current Veterinarian/Clinic Address

Current Veterinarian/Clinic Phone

Select All Vaccinations the dog has received in the past year.

Is the dog currently heartworm preventative?

Date of last heartworm treatment (pill or shot)

Date of last heartworm blood test

What was the result of the heartworm test?

If positive, did the dog undergo treatment?

Has the dog had any surgeries besides being spayed/neutered?

If yes, explain the surgery and date of surgery.

Does the dog have any known medical issues or known allergies?

If yes, please explain the allergies and treatment:

Has the dog been bred?

If yes, how many times has the dog been bred?

Did you receive your dog from a breeder?

If no, where did you get the dog?

If yes, Please provide the Breeder’s Name/Kennel’s Name.

Breeder's Website

Breeder's E-mail

Breeder's Phone

Do you have contact with the breeder?

Have you contacted the breeder about taking the dog back?

If yes, what was the breeder's response?

Other Information

When we take a dog in, we keep it in our home with our family and pets as well as in our temperature control barns. Whether it takes weeks or months to find it a home, we keep the dog with us and incur the cost of it's care and vetting. We rely on donations and are not funded through the city or state. We pay for our rescue work out of our own pockets. It is partially funded by our adoption fees, but does not come close to covering all of our expenses during the year.

Amount of donation offered to help us cover the cost of vetting/caring for this dog? $200

Please take 3 good quality, well lit photographs of the animal and email them to us at with your name and the animal's name in the subject of the email. If you have any videos of the dog, please send us the links to them on youtube.

Email: Hardlickerranch@outlook.com

By checking the Medical Release box and signing below, I certify that the information I am about to provide is true and correct. Additionally, I agree to call my veterinary clinic and give permission for the release of my pet’s medical records to a representative of Hard Licker Ranch.

By checking the Release of Pet Ownership box and signing below, I hereby transfer full ownership, right and responsibility of the dog to Hard Licker Ranch. I understand that after this date I shall have no interest or right to the dog and all decisions regarding the dog shall be made at Hard Licker Ranch's sole discretion. I further understand that I am not eligible to adopt the surrendered dog back from Hard Licker Ranch.

By checking the Liability Release & Waiver box and signing below, I accept this waiver and release Hard Licker Ranch from any and all liability. I am certifying that all the answers I have given are the truth. I also understand that this information might be shared with another rescue group if they call Hard Licker Ranch to inquire about the listed applicant(s).

To the best of my knowledge, the information I provided accurate and truthful.

Today's Date:

Signature: