SRNJ Surrender Form

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SRNJ Surrender Form

If you are looking to re-home or surrender your Shiba please fill out the following form. Please note that this is an all volunteer organization. We are limited in the number of Shibas we can foster and space may not be immediately available. Also, please send a picture(s) of your dog to inurescue@gmail.com Please put in subject surrender dog's name.

Email *

First and last name? *

Complete Address City, State and Zip *

Best phone number to reach you at? *

Work phone with area code? *

Dog name? *

Dog gender? *

Female

In-tact Male

Spayed Female

Neutered Male

Other:

Age of dog? *

Please check all that apply: *

Aggression towards other dogs

Aggression towards cats

Food agression

Toy Agression

Walks on the leash

Crate trained

House broken

Neutered/Spayed

Up to date on shots

Has bitten other dogs

Has bitten humans

Is good around children

Dog is on heart worm preventative

Dog is microchipped

Other:

Required

Does the dog have any medical conditions? (treated or untreated) *

Can you hold onto the dog while a new home is found? *

Yes

When do you need a new home by? *

Why are you surrendering your dog? *

A surrender fee/donation is required. For dogs under 3 years, the fee is $250, for dogs between 3-7 the fee is $350 and the fee for dogs over the age of 7 is $450. This surrender fee may be waived if the dog is up to date on vaccinations, is spayed/neutered and on heart worm medication (proof of vaccination and spay certificate is required). By dating and typing my initials in the space below I certify that I am the owner of, or have authority to surrender to Shiba Rescue of New Jersey, the animal described above. If SRNJ accepts the dog into rescue, the undersigned relinquishes all rights of ownership and any right to information on the disposition of said animal. I also authorize the release of any veterinary records regarding the animal. I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behavior, history and anything else that may affect the safe placement of the animal in a new home, and that all statements made above are true and correct. *

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