Petstablished | Manage your Animal Welfare Organization (AWO) with our easy-to-use software.

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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

Request to Surrender Puppy/Dog (NO Cats or other animals)

We know that sometimes life happens and people find themselves unable to properly care for their dog. Our greatest fear is that someone will feel so desperate that they consider giving or selling their dog to a stranger. Without the required references and home checks performed by rescue groups, dogs run the risk of being placed into unhealthy and abusive homes. We want to ensure your loved one gets the home they deserve.

Before you make the decision to surrender, give away, or sell your dog, we may be able to help you find solutions that will allow you to keep your dog as a member of the family. While we can't guarantee miracles, we do have extensive experience dealing with a multitude of issues and can certainly offer suggestions and alternatives to giving up your dog.

Are you the legal owner of the dog? Able to provide proof of ownership?

YesNo

Puppy/Dogs Name

Breed (If mixed, most prominent)

Age (Please list Date of Birth if known)

Weight (As close as possible please)

Any Bite History?

YesNo

If there have been any bites, explain in detail the situation that led up to the bite(s)

Is He/She good with?

DogsCatsChildren Under 5 years oldChildren Over 5 years oldMenWomenLivestock (Including Chickens, Cattle, Horses, Goats, Sheep, etc)MUST be ONLY Pet

Are there any medical conditions/needs that we need to be aware of? Are they on medication?

Are they Spayed / Neutered?

Spayed (Female)Neutered (Male)No

Are they current on Vaccines? (Most are good for 1 year, some 3 years)

YesNo

ANY Behavioral issues that we need to know about?

If found where did you find the dog. (Location, date, and time)

Submit pictures of the dog. (So we can see the conditions of the dog.)

Do you have any medical files?

Are they Microchipped? If So, List the Company and Number

How many homes has this dog had

Reason for Surrender, Please be very specific

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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Surrender Request (Does NOT Guarantee we can take in your dog)

Personal Information

Request to Surrender Puppy/Dog (NO Cats or other animals)