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Owner Surrender Questionnaire
Complete this form for surrender of a DOG to Cherokee County Animal Shelter
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
Dog's Name
*
Your answer
Breed
*
Your answer
Sex of Dog
*
Choose
Male
Female
Spayed or Neutered
*
Yes
No
Unknown
Age
Puppy
0
1
2
3
4
5
6
7
8
9
10
Adult
Clear selection
Why are you surrendering your pet?
*
Choose
Moving
Allergies
Not Housebroken
Behavior of pet
No time for pet
Cannot Afford
Health of Animal
Unwanted Litter
Size of Animal
New Baby
Where did you get your pet?
Choose
Adopted from a Shelter or Rescue
Stray
Breeder
Friend/Family
Gift
Newspaper/Internet
Other
Current on Vaccines?
*
Yes
No
Unknown
What is the name of the last vet your pet visited? ***Please bring any medical records you may have.
Your answer
Does this pet have any medical conditions or previous injuries?
*
Yes
No
If yes to the last question, please explain
Your answer
Has this pet ever bitten a person or other animal?
*
Yes
No
If yes to the last question, please explain
Your answer
Where did your dog spend most of it's time?
*
Choose
Indoors
Outside
Is your dog housebroken?
*
Yes
No
Is your dog crate trained?
*
Yes
No
What type of food does this pet eat?
Dry
Canned
Dry & Canned
Special Diet (please specify in ADDITIONAL NOTES section below)
Clear selection
Has your dog ever been around other dogs?
*
Yes
No
Does your dog play well with other dogs?
*
Yes
No
Unknown
Has your dog ever lived in a home with children?
*
Yes
No
Has your dog ever lived in a home with cats?
*
Yes
No
Is your dog microchipped? IF yes, have you contacted your alternate contact on the chip in reference to rehoming this pet?
*
Yes
No
Microchipped
Tried rehoming to alternate contact
Yes
No
Microchipped
Tried rehoming to alternate contact
Is your dog fearful of....
Choose
Men
Women
Storms
The Vet
Children
Strangers
Riding in the car
Bathing
Other
NONE OF THE ABOVE
Does this pet have any behavior issues or destructive tendencies?
*
Yes
No
If yes to the last question, please explain
Your answer
Have you tried to rehome your pet?
*
Yes
No
How long have you been trying
Day
1
2
3
4
5
6
7
8
9
10
Days
Clear selection
Any other ADDITIONAL NOTES that you would like to share with the staff about your pet:
Your answer
If you are surrendering this pet due to behavior issues, is it your intent that it be euthanized?
Yes
No
Clear selection
Do you understand that when you surrender this animal to us that it is highly possible that we will have to euthanize this animal (put it to sleep)?
*
Yes
No
Your submission will be sent to the intake department of Cherokee County Animal Shelter. You will receive a link to make an appointment after you submit your form.
131 Chattin Drive Canton Georgia 678-493-4387
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