Dachshund Haus 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.

Email address *
Owner's name: *
Your answer
Dog's name: *
Your answer
Address: *
Your answer
Phone: *
Your answer
Dog's birth date (or best guess): *
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Dog's Breed? *
Your answer
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:
Your answer
Does your dog have a microchip? *
If your dog has a microchip, what is the number?
Your answer
Veterinarian's name: *
Your answer
Veterinarian's phone: *
Your answer
Veterinarian's address: *
Your answer
Why do you need to surrender your dog? *
Your answer
Does your dog have any medical conditions that you know of? If so, what ones? *
Your answer
How long has this dog lived with you? *
Your answer
Where did you get this dog? *
Your answer
Where did you leave your dog when he/she was alone? (free roaming, crate, bedroom, etc) *
Your answer
Where does your dog sleep at night? *
Your answer
Do you trust your dog loose indoors, unsupervised? If no, why? *
Your answer
How does your dog tell you he/she needs to go potty? *
Your answer
What types of animals has your dog lived with? (please include sex, species, etc) *
Your answer
Please describe how they got along. *
Your answer
What ages of children has your dog lived with? Visited with? *
Your answer
Comments about your dog and children?
Your answer
What are your dog's shining qualities? *
Your answer
Does your dog travel well in a car? *
Is your dog aggressively protective of his/her: (check all that apply) *
Required
Please list anything else that may be pertinent for a foster parent/adoptive parent to know about your dog.
Your answer
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 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 Rescue I am relinquishing my ownership. Dachshund Haus 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 Rescue is a no kill facility but in the case of severe illness, pain or extreme aggression my dog may be humanely euthanized. Selecting "Yes" serves as my digital signature and by signing this agreement I release, hold harmless and forever discharge Dachshund Haus 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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