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 a signed copy of the Surrender Statement as well as 5 photos of your dog, 3 of which must be close-ups.
Contact Information
Your Name

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
Home Address

Street Address

Street Address Line 2

City State / Province

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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Vet phone number:

Area Code Phone Number
Surrender Statement and Photos
Click here to download the Surrender Statement.
Please upload a signed copy of the Surrender Statement:
Please upload 5 photos of the dog, including 3 close-up photos:

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Dog Surrender Request Form