Canine Owner Surrender/Return
Your Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Best Phone Number to reach you *
Your answer
Email Address *
Your answer
Dog's Name *
Your answer
Did you adopt your dog from Pet Haven? *
What breed is your dog? *
Your answer
How much does your dog weigh? *
Your answer
Dog's Age *
Your answer
Dog's Gender *
Briefly explain why you are looking to surrender your dog. *
Your answer
Pet Haven does our best to find fosters for all of the dogs that we can and will always be able to help a dog that was adopted from Pet Haven, but some dogs are more difficult to place and may take days to weeks to find and appropriate and safe foster home for. Some dogs may be easiest fostered by their surrendering owners. Keeping this in mind, how long are you able to continue to house the dog?" *
Your answer
Household History
Where did you get your dog? *
Your answer
How long have you owned your dog? *
Your answer
Are there any wonderful, special traits or habits that you would like his/her new family to know about?
Your answer
Is your dog housetrained? *
Your answer
Does your dog have accidents in the house? *
If yes, how often?
How long can your dog "hold it"? *
Is your dog crate trained? *
If yes, how long did the dog spend in the crate each day?
Your answer
How long is your dog left alone, without people? *
When alone, is your dog: *
When alone, does your dog (check all that apply): *
Required
If your dog destroys household items, does he or she:
When you are home, does your dog (check all that apply): *
Required
How does your dog react to bathing / handling such as petting or hugging?
Your answer
Does your dog get along with other dogs? *
Your answer
Does your dog get along with cats? *
Your answer
Does your dog like children? *
Your answer
Are there areas on the dog’s body your dog does NOT like to be touched?
If touched in the above place(s), how does your dog respond?
Has your dog ever bitten a person? *
If your dog has bitten a person, please describe the bite(s).
Your answer
Is the dog permitted to sit and/or sleep on furniture?
Has your dog completed any training? If yes, please describe.
Your answer
How does your dog behave in the car?
What words does your dog understand?
What are the dog’s favorite kinds of toys?
Your answer
How does your dog react when you or another family member...
...pet him/her or touch the bowl or food while eating?
...pet him/her or touch a bone, rawhide, pig’s ear or other delicious edible while chewing?
...pet him/her or touch a stolen food item?
...pet him/her or touch a toy in his/her mouth?
...pet him/her or move him/her while sleeping?
....push or pull him/her off of furniture?
....approach him/her while next to another family member?
Medical History
Has your dog ever had surgery?
If yes, please explain:
Your answer
How does your dog behave during visits to the vet?
Your answer
Is your dog up to date on vaccinations? Please mark all that apply: *
Required
Is your dog spayed or neutered? *
Required
Has your dog been tested for Heartworm? *
Required
Please provide your veterinarian's name and phone number (Pet Haven will require records prior to placement)
Your answer
Is there anything you want a new family to know about your dog’s interaction with men, women, children, other dogs, cats, or other animals or people?
Your answer
Are you interested in discussing options other than surrender with a Pet Haven representative (such as training techniques or behavior assistance?)
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