Dog Surrender Form

We understand that surrendering a dog is a difficult decision. Please fill out this form completely so we can find the best possible outcome for your dog. Submitting this form does not guarantee placement — we will contact you to discuss next steps.

Your Information

First name *

Last name *

Street address *

City *

State *

Zip code *

Email *

Home phone *

Cell phone *

Veterinarian

Veterinarian / Practice name

Veterinarian's phone

About Your Dog

Dog's name

Breed

Is your dog male or female? *

Male Female

Is your dog spayed or neutered? *

Yes No

Dog's birth date or age *

Dog's weight *

Where was the dog obtained?

When was the dog obtained?

Health

Up to date on rabies vaccination? *

Yes No

Up to date on DHLPP vaccination? *

Yes No

Receives heartworm preventatives? *

Yes No

Receives flea and tick control? *

Yes No

Current injuries or illnesses *

Reason for Surrender

Please explain why you are surrendering your dog. *

Additional information

Consent

I have read and answered each question on this form and provided truthful answers. I give permission to GSDRHCEC to contact my veterinarian for medical records. I understand that submitting this form does not guarantee placement and that the rescue will contact me to discuss next steps. Submission of this form provides a signature.

I agree I do not agree