Animal Surrender / Intake Request
Thank you for seeking a safe way to rehome your dog or stray animal. We receive many requests weekly for pet surrenders, and our currently response time is between 1-2 weeks. From there we will set up a meeting with you and your pet, to make sure we can safely find a great home for your pet. Lastly we will set up a date for your pet to be relinquished to our program.

If there is anything we can do to help you keep your dog, please let us know!

Name: *
Your answer
Phone Number: *
Your answer
Email: *
Your answer
Your Address: *
Your answer
Dog's Name: *
Your answer
Dog Breed: *
Your answer
Dog Colors: *
Your answer
Dog Age: *
Dog's Approximate Weight: *
Is Your Dog Spayed or Neutered? *
Are you able to provide current vaccination records for your dog? *
Where did you get the dog? *
If adopted, what rescue/shelter?
Your answer
Kennel trained? *
House trained? *
Socialization? *
Does the dog get along with (mark all that apply):
Some Dogs
Birds (chickens, ducks)
Row 1
Tell us about your dog's personality? *
Your answer
Does your dog have any known health issues? *
Why do you want to surrender your dog? *
Your answer
Is there anything we can do to help you keep your dog rather than surrendering? *
Your answer
Please consider making a donation at
Your answer
After submitting this form, we will need photos emailed to or messaged to us on Facebook at in order to help.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service