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Surrender Form

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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 Information

Tell us about your dog

If found as a stray, has the dog been reported to your local municipal animal control?

YesNoN/A

What is the dog's name?

Approximate Age

Dogs Gender

MaleFemaleUnknown

To the best of your knowledge, what is the dog's breed?

Does your dog have any history of aggression towards humans or bitten a human? If yes, please explain.

Does your dog have any history of aggression towards other dogs or bitten another dog? If yes, please explain.

How does your dog do with cats? Children?

How long have you had this dog?

What is this dog's energy level like?

For example: calm, needs a lot of exercise, doesn't have a stop button, settles at home nicely

How does your dog respond to being left alone?

For example: needs to be crated, vocal, calm

Please add anything else you would like us to know.

Are you willing to foster until the dog is adopted? We provide all medical care and supplies. Renegade Paws is a completely foster based organization so if you are able to foster, our chances of being able to help you are dramatically higher.

Why are you rehoming this dog?

Guardian passed awayGuardian ill and unable to care for dogDog has behavior issuesGuardian has housing issuesFinancial concernsFound as strayOther

Where did you get this dog?

Example: from a rescue, shelter, family member, friend, breeder, etc. If adopted, please check your adoption contract for a return clause. Many facilities require the dog to be returned to them.

Is the dog neutered/spayed?

YesNoUnknown

Photo

Please attach a photo of your dog.

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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