Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.
Dog's name
Dog's breed
Dog's age/date of birth
Dog's sex
Dog's weight
Name of veterinarian/vet clinic
Phone number of veterinarian/vet clinic
When did the dog last visit the vet and why?
Can you provide current vaccination records for Bordetella?
Can you provide current vaccination records for Parvo/Distemper combo?
Can you provide current vaccination records for Rabies?
Are you the dog's original owner?
How long have you had the dog?
How did you get the dog? If adopted from a rescue or shelter, we may be able to help facilitate the dog being returned to that organization.
Why are you surrendering the dog?
Has the dog ever bitten anyone?
If yes, please explain. If no, enter N/A.
Where has the dog been kept?
Is the dog housebroken?
Please check all that apply:
What and how much do you feed the dog?
Does the dog have any special dietary needs?
Does the dog have any special medical needs?
Where does the dog sleep at night?
Is the dog afraid of anything in particular?
Check all commands the dog knows:
Does the dog know any other commands?
What is your favorite thing to do with the dog?
Check any traits/behaviors that describe the dog:
How is the dog with children?
How is the dog around cats?
Is the dog good with male dogs?
Is the dog good with female dogs?
I certify that I am at least 18 years of age and I am the legal or designated owner of the dog, and that the information above—and in other verbal and written communications about the dog—are provided to the best of my knowledge and belief. I understand that a fee is due to Because Animals Matter (BAM) for accepting my dog into their program ($50 for a dog that is already spayed/neutered and up to date on vaccinations; $100 for a dog requiring surgical alteration or vetting).
I agree that by submitting this form I am only asking to surrender a dog to BAM. I understand that my application must be approved before I will be allowed to surrender a dog to BAM, and that my application may be denied and I may not be permitted to surrender a dog to BAM.
I hereby release the dog described above to Because Animals Matter. I turn over full responsibility and ownership to BAM. I agree to indemnify and hold harmless BAM and its agents from any claims arising from this pet and transfer of it.
Signature of dog owner requesting relinquishment:
_____________________________________________________________________ Date: _________________
Signature of BAM representative:
Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.