Animal Surrender/Intake Request

Brick City Rescue, Inc
Dog Surrender/Intake Request
If you are looking to rehome your dog, we will review the submitted form and decide if we can take on your case based on the information given to us. Please fill out the form below and be as truthful and detailed as possible. We accept a $250 surrender fee and if we decide your dog is NOT a good candidate for BCR, we will then refund the $250 surrender fee to you. We accept dogs on a case to case basis as we are a foster based rescue.Therefore, we need open, viable fosters to place your dog. Thank you. BCR Team
Your Name*
Your Email*
Your Phone*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Animal's Name*
Breed*
Color(s)*
Age*

Under 8 weeks8 weeks to 4 months4 months to 1 year1-3 years3-6 years6-9 years9+ years
Approximate Weight

15-35 lb35-55 lb55-75 lb75 lbs or over
Socialization

Sweet and socialA little shy but warms up when you're niceVery shyFear aggressiveFear biterDog FriendlyCat FriendlyChild FriendlyCalmActiveOther
Has your dog had any vaccinations, heartworm testing, has it been altered (spayed or neutered)? If so, please describe.
What is your reason for surrender?
Amount of donation offered to help us cover the cost of caring for this dog:
Surrender Fee due at submission
Please take 3 good quality, well lit photographs of the animal and email them to us at
info@brickcityrescue.com with your name and the animal's name in the subject of the email. If you have any videos of the dog, please send us those as well.
Should be Empty:

Brick City Rescue, Inc

Dog Surrender/Intake Request