Owner/Stray Surrender Form

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By signing this form, I state that I am the owner or finder of the dog on this surrender form, hereinafter referred to as the "pet". To my knowledge, no other person has any ownership rights to the dog I am surrendering. All records of health, including vaccinations and microchipping, will be given at the time of surrender.
I hereby surrender my pet to Rudy's Rescue. I understand and acknowledge I am giving up all rights to my pet and my pet will not be returned to me.

PLEASE ANSWER ALL QUESTIONS COMPLETELY

Email *

Owner/Finder Name *

Contact number *

Address *

From who, or where did you get your pet?

Pet Name/Breed/Color *

Age/Weight/Birthday if known *

Years/Months owned *

Male or Female

Male

Female

Clear selection

Spayed/Neutered *

Yes

Current Veterinarian *

Last Vet Visit *

Vaccinations Current *

Yes

Current Health Condition *

Past health conditions we should know about: *

Is your pet on any medication at time of surrender? Please list: *

What kind of food is your pet eating? *

At what times of the day do you feed your pet? *

Heartworm preventative given? When was last dose given? *

Is your pet micro chipped? If so, is the chip registered with your contact information? *

Is your pet housebroken? *

Yes

Good with: *

Medium to large dogs

Small dogs

Cats

Farm animals (goats, chickens, cows, horses, etc.)

Kids

Female adults

Male adults

Required

Does your pet have or had any behavior problems? Please describe. *

Has your pet ever bitten or broken the skin of another pet or person? *

Yes

Where does your pet sleep at night?

Does your pet enjoy riding in a vehicle? *

Is your pet leash trained? *

Yes

Is your pet crate trained? *

Yes

How many hours does your pet stay in a crate during the day? *

Does your pet have anxiety during fireworks, storms, or when left alone? Please explain. *

Would you like to donate funds to help with the care of your animal or other animals in foster care? You may donate through Venmo or PayPal to rudysdogrescue@gmail.com *

Yes

Please describe in detail why you must surrender your pet. *

Signature/Date *

Submit

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