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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Information About The Dog

Please answer all questions as fully as possible to help our staff assess our ability to help.

Name of Dog(s)

Please list all dogs you are looking to surrender

Breed of dog(s)?

Please list all dog breeds, or approximate dog breeds and sizes

Age of Dog(s)

Please list how old each dog is

REASON FOR ADMISSION?

Spayed or Neutered?

If not altered, we recommend an additional surrender fee to help cover the cost of surgery.

YesNoUnknownSome are fixed, some aren't

Up-to-date on rabies vaccine?

Please provide proof of rabies vaccination by uploading it, emailing it to info@spcahancockcounty.org or by bringing it to your surrender appointment.

YesNoUnknown

How did you acquire this dog?

For the purpose of the remainder of the admission form, we will be asking about a singular dog, but this form continues to apply to all dogs you are trying to admit to the SPCA of Hancock County. Please consider all dogs you are trying to surrender in your answers.

HOUSEBROKEN?

YesNoMostly

MEDICAL/HEALTH ISSUES?

Veterinarian Clinic Name and phone number

If no clinic, please put N/A

To expedite the admissions process, please contact your veterinarian and have copies of your animal's health records sent to the SPCA of Hancock County via email to info@spcahancockcounty.org, fax to 207-667-8011, or bring the records with you to your surrender appointment. You may upload these records now if you have them.

You may upload JPEGs, PNGs, or PDFs.

Has this dog ever bitten a person?

YesNo

Did the bite require a doctor's visit or medical attention?

What were the circumstances of the bite?

How long have you owned this dog?

What do you know about this dog's history before it came to live with you?

If the dog has lived with you since it was a young puppy, put "got as a puppy"

Does this dog get along with other dogs?

YesNoUnknownDoes not like living with other dogs but is okay walking by them

Does this dog get along safely with cats?

YesNoUnknownNeeds more training - will chase cats but does not mean harm

Please explain any concerns about other animal interactions.

Is it safe for this dog to be with small children?

YesNoWith supervisionUnknown

Please describe any concerns you may have about your dog and children

How does the dog behave when meeting new people?

Please describe.

When on a leash, how does the dog behave when meeting another dog?

Please describe.

How long can you leave your dog alone for?

Is the dog loose when left alone?

YesNo

If you answered NO, where is the dog kept?

What commands does your dog know?

How would you describe your dog's energy level?

High energyNormal/medium energyLow energy

What frightens or irritates your dog?

Common triggers are lightning/thunder, fireworks, other loud noises, etc.

Can your dog be off leash?

YesNoOnly when fenced in

If NO please explain when your dog cannot be off leash

Is there any part of your dog's body that is sensitive to touch or that it does not like touched?

Is it safe to leave your dog unsupervised in a fenced-in yard?

YesNoI don't know

Legal

By submitting this application, I understand that this shelter has the right to accept or deny my surrender application. I acknowledge that only persons who have legal ownership over an animal have the right to relinquish it and that the SPCA cannot accept an animal from me if I am not the legal owner or if I am not authorized to act on behalf of the legal owner.

I understand that the SPCA of Hancock County is a not-for-profit organization and that there are recommended surrender fees. I acknowledge that the surrender fees are the following:
DOGS:
Recommended donation of $45 for a single puppy 5 months and younger
Recommended donation of $50 for a single dog 6 months and older that is current on vaccinations and has been spayed/neutered
Recommended donation of $75 for a single dog 6 months and older that is NOT current on vaccinations or is NOT spayed or neutered

I understand it may take a few days for an SPCA representative to call me, after reviewing this application.

By checking this box, you are agreeing to all terms and conditions, and clicking "I accept" is recognized as your electronic signature in lieu of a standard signature.

I accept all terms

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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Dog Admissions Form

Personal Information

Information About The Dog

Legal