Owner Surrender Request Form
We ask for you to be willing to transport the dog you are surrendering to the Dayton or Columbus area based upon our availability. Our ability to bring dogs into the rescue is based on having a suitable foster home or an available spot in our training program, as well as our available funding for extensive medical issues, our fosters' level of experience, and history with our ability to place your dog. We do not accept bite risk or aggressive dogs, and are sometimes limited in which breeds we can take based upon the rules of the correctional institution. We are a rescue overwhelmed by the volume of pets needing rehomed, as are all other rescues and shelters. Additionally, we are 100% volunteer-based, so please be patient in awaiting a reply from us. If you are able to bring your dog up to date on vaccines and have them spay/neutered, that will assist in our ability to take them sooner. Thank you!
Owner Name
*
First Name
Last Name
Address (no P.O. Boxes please)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
-
Area Code
Phone Number
Best time to call?
*
Please Select
Mornings
Afternoons
Evenings
Any
E-mail
*
What is the dog's name?
*
Gender?
*
Male
Female
What is the breed or mix?
*
Why are you surrendering the dog?
*
Approximate age of dog?
*
How much does the dog weigh (or an approx estimate)?
Is the dog spayed or neutered?
*
Yes
No
Is the dog current on vaccines?
*
Yes
No
Heartworm prevention (such as Heartguard, Tri-Heart, etc)?
*
Yes
No
Is the dog an inside dog?
*
Yes
No
If no, please explain
Does the dog get along with other dogs?
*
Yes
No
Don't know
Does the dog get along with cats?
*
Yes
No
Don't know
Do you trust your dog around children? Please explain their exposure and to what age of childern, if any
*
Does the dog have any behavior issues: dog aggression, aggresion towards people, children, food, toys, separation anxiety, housebreaking, etc. Please explain in detail.
*
Does the dog have any health issues?
*
Yes
No
If yes, please explain
Has the dog ever bitten anyone? Including another animal. You ARE required by law to disclose any bite histories. Failure to do so can result in legal action against you.
*
Yes
No
If yes, please explain
Please provide your vet's name, address, and phone number used for this dog. Please notify the vet that we will be contacting them and provide consent to release information to us. This will prevent delays in processing your request.
*
Did you previously adopt this dog from a rescue or animal shelter?
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Yes
No
If yes, please list who you adopted the dog from. You are required to contact the agency you adopted the dog from as typically they require return of said dog. Please be prepared to show that the agency will NOT take the dog back.
Did you purchase this dog from a breeder? If yes, you are required to contact the breeder first as a reputable breeder will always take one of their dogs back. Please be prepared to show that the breeder refuses to take the dog back.
*
Yes
No
What other efforts have you made to rehome the dog and are any options ongoing? Have you contacted other rescues or posted the dog publicly on any rehoming sites? Please provide details.
Any additional comments that will helps us?
Submit
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