Dachshund Haus and Corgi Owner Surrender Form
We are sorry that you have had to make the decision to surrender your dog. We DO ACCEPT owner surrenders based on AVAILABLE SPACE. Our spaces are very limited and are based on a quota system. We have a certain number of spaces available for senior/special needs dogs, adult dogs, youths and puppies. IF we have a space available, our Intake Specialist will contact you and arrange for you to bring the dog to our rescue. We do NOT TRANSPORT dogs, so you will need to make arrangements to get your dog to one of our volunteers.

The more information you can give us about your pet, the easier it makes it for us to get him/her adopted.

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Email *
Owner's name: *
Dog's name: *
Address: *
Phone: *
Dog's birth date (or best guess): *
Dog's Breed? *
Please provide the name, location, and phone number of any veterinarians this dog has seen. *
Have you, or anyone else,  ever used a correction/shock collar on this dog? *
Is your dog spayed/neutered? *
Is  your dog up to date on rabies vaccine? *
Do you have a rabies tag or certificate? *
Has this dog had monthly heart worm medicine? *
Has this dog bitten anyone in the last 10 days? *
If yes, please explain:
Does your dog have a microchip? *
If your dog has a microchip, what is the number?
Veterinarian's name: *
Veterinarian's phone: *
Veterinarian's address: *
Why do you need to surrender your dog? *
Does your dog have any medical conditions that you know of? If so, what ones? *
How long has this dog lived with you? *
Where did you get this dog? *
Where did you leave your dog when he/she was alone? (free roaming, crate, bedroom, etc) *
Where does your dog sleep at night? *
Do you trust your dog loose indoors, unsupervised? If no, why? *
How does your dog tell you he/she needs to go potty? *
What types of animals has your dog lived with? (please include sex, species, etc) *
Please describe how they got along. *
What ages of children has your dog lived with? Visited with? *
Comments about your dog and children?
What are your dog's shining qualities? *
Does your dog travel well in a car? *
Is your dog aggressively protective of his/her: (check all that apply) *
Please list anything else that may be pertinent for a foster parent/adoptive parent to know about your dog.
By selecting "Yes" I acknowledge that all the information is true and complete to the best of my knowledge. I am the legal owner of this dog and authorized to re-home/relinquish this dog to Dachshund Haus and Corgi Rescue. I have not signed any contracts requiring me by law to return this dog to any breeder or other rescue organization. I also acknowledge that by surrendering my dog to Dachshund Haus and Corgi Rescue I am relinquishing my ownership. Dachshund Haus and Corgi Rescue will do its best to keep bonded dogs together but I understand that in some instances bonded dogs must be separated to find acceptable homes.  I understand that Dachshund Haus and Corgi Rescue is a no kill facility but in the case of severe illness, pain or extreme aggression my dog may be humanely euthanized. I also understand that in the event that I change my mind, within five days, there is a $25 boarding fee per day. This fee must be paid prior to picking up my dog. I also understand that Dachshund Haus and Corgi Rescue is not obligated to return my dog to me, and may not be able to honor requests to return dogs. Selecting "Yes" serves as my digital signature and by signing this agreement I release, hold harmless and forever discharge Dachshund Haus and Corgi Rescue any and all claims arising from fostering this rescue dog. *
A copy of your responses will be emailed to the address you provided.
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