SCD Dog Surrender Request Form

Dog Surrender Request Form
Please note that this form is the first step in the process of determining how and if Second Chance Dogs can help your dog. A Second Chance Dogs representative will need to evaluate the dog.

A surrender donation allows us to rescue, rehabilitate, and rehome more dogs.

Second Chance Dogs is a non-profit 501(c)3 organization.
Please note that in order to submit this form, you will need to upload 5 photos of your dog, 3 of which must be close-ups.
Contact Information
Your Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dog's Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of veterinarian who has the dog's records:
Vet address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vet phone number:

Area CodePhone Number
SURRENDER STATEMENT

I, (State your name below) surrender my dog(s) to Second Chance Dogs. The information submitted in the surrender form is true and SCD has permission to contact my veterinarian.
Name

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Surrender Photos
Please upload 5 photos of the dog, including 3 close-up photos:

Choose Files

Cancelof
Should be Empty:

Dog Surrender Request Form