Owner Surrender Application

Please remember to hit "SUBMIT" at the end or your information will not be saved and sent to us. Contact us at handsofhopegb@cox.net with any questions regarding this form. Thank you!

DO NOT USE YOUR PHONE OR TABLET TO FILL OUT THE FOSTER APPLICATION AS IT IS NOT COMPATIBLE!!!!

Full Name of Owners*

First NameLast Name

Full Name of Owners

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number - Home*

Area CodePhone Number

Phone Number - Cellular*

Area CodePhone Number

Work Phone Number *

Area CodePhone Number

Email*

example@example.com

Reason for wanting to surrender dog. (Please be truthful, it will be an automatic "NO" if we find discrepancies, as we are foster based and need to make sure we are able to accommodate.*

Name, breed and age of dog to be surrendered*

Male or Female*

MaleFemale

Is this dog current on vaccinations, spayed/neutered, and can records be provided?*

YesNo

Name and address of current veterinarian

Name

Address

CityState / Province

Postal / Zip Code

Phone # of veterinarian

Area CodePhone Number

Is the dog microchipped? If yes, please enter the chip number and company below.*

YesNo

Is the dog house trained?*

YesNo

Is the dog crate trained?*

YesNoWorking on it

Does the dog get along with other MALE AND FEMALE dogs? What sizes has the dog been exposed to?*

Is the dog "cat friendly?*

Has the dog ever shown aggression or attacked another dog? If so, please explain in detail what happened.*

Is this dog good with children?*

Has this dog ever shown signs of aggression or bitten a child or adult? If so, please explain in detail.*

It is imperative that we know any issues your dog may have in order to place him/her. Please write any behavior issues, food aggression, treat/toy aggression, or anything else that will be helpful in training in order to help this dog.*

Please list any training this dog has had or commands/tricks this dog knows*

I, *, relinquish ownership and responsibility of *, to Hands of Hope Rescue for the purpose of rehoming or finding a suitable rescue for said dog. I have completed this form and verify all statements made to be true and accurate to the best of my knowledge.

Signature*

Date*

Date

Please allow us the adequate time of at least 48 hours to evaluate and asses our fosters to determine if we are able to find placement for this dog. You will receive notification of our receipt of this online surrender form, if you do not receive notice of receipt or we have not contacted you within the requested 48 hour period please email us at handsofhopegb@cox.net.

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in denial of this application. I certify that the above information is correct, and I understand that the information will be verified.

DO NOT USE YOUR PHONE OR TABLET TO FILL OUT THE FOSTER APPLICATION AS IT IS NOT COMPATIBLE!!!!