Surrender Form
Filling out this form is the first step in the surrendering process. You are not required to surrender the dog once your form is submitted, and submitting this form does not guarantee we will accept your dog. Please answer all questions below honestly and to the best of your ability. This information gives us valuable insight and helps ensure the dog has a successful adoption. Please double check that your phone number and email address are entered correctly, otherwise we'll be unable to contact you. If we're able to help, we'll be in touch.
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Your Full Name: *
Phone Number: *
Email Address: *
Date of Birth: *
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Full Physical Address: *
*INCLUDE CITY AND ZIP CODE* We're currently unable to accept dogs from Oregon due to a lack of available foster homes in the area.
• GENERAL INFORMATION •
Dog's Name: *
Breed: *
Age: *
Sex: *
Is your dog spayed / neutered? *
What kind of ID does your dog have? *
• HISTORY •
Why are you surrendering your dog? *
If we could help you resolve this issue, would you be interested in keeping your dog? *
Where and how did you acquire your dog? *
How long have you owned your dog? *
Has your dog ever bitten anyone? *
If yes, under what circumstances and when?
If yes, is the incident documented with By-law, Animal Control, or Public Health?
• MEDICAL HISTORY •
What veterinary clinic does your dog visit? *
Has your dog seen a veterinarian at least once a year? *
Is your dog currently up to date with vaccines? *
Date of last vaccination:
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Does your dog have any current medical issues? *
Has your dog ever been diagnosed with and/or treated for any medical problems? *
If yes, please explain:
Has your dog ever received any medical surgery? *
If yes, please explain:
Is your dog currently receiving any medication? If yes, please list them:
Is your dog eating a prescription diet? If yes, please explain:
• PERSONALITY •
How would you describe your dog’s personality most of the time? *
Check all that apply
Required
How does your dog like to play? *
• LIFESTYLE & HOME LIFE •
Where does your dog spend most of their time? *
Are there any restrictions to your dog in the house (i.e. not allowed on furniture, the carpet, the upper level of the house, etc.)? *
How does your dog interact with other dogs? *
How does your dog interact with cats? *
Has your dog regularly been around children? * *
If yes, what ages are the children?
How did your dog and the child interact?
Have the experiences with your dog and the child(ren) always been positive?
If no, please explain:
Is your dog most comfortable with: *
Required
Please tell us some things your dog dislikes: *
Are there any quirks or habits you are not fond of in your dog?
This information gives us valuable insight and helps ensure the dog has a successful adoption. Many quirks or habits are common behaviors natural to all dogs and/or have simple solutions to resolve, which we can share with a future adoptive family.
• DIETARY HABITS •
What is your dog’s favorite brand of food? *
Which does your dog eat? *
Required
How often is your dog fed? *
• TRAINING •
Is your dog housetrained? *
Has your dog received any obedience training? *
If yes, from whom and what methods were used?
Which basic commands does your dog know?
What walking equipment works best for your dog? *
Examples: flat collar, head halter, front-clip control harness, pressure harness, limited slip collar, prong collar, choke chain, electric collar
How is your dog's behavior off leash? *
Is your dog used to being in a fenced yard? *
Will your dog chew household items when left alone? *
Has your dog been crate trained? *
How is your dog's behavior in the car? *
Is there anything else you would like us to know about your dog?
• ELECTRONIC SIGNATURE •
BY TYPING MY NAME BELOW I AUTHORIZE THAT ALL OF THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS, TO THE BEST OF MY KNOWLEDGE, TRUE AND COMPLETE. *
I understand the fee to surrender my dog to MMR is $150: *
Required
If you have photos of your dog, please email them directly to info@misunderstoodmutts.org with the dog's name in the subject line.
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