Owner Surrender Form

Owner Surrender Agreement

Please complete this form for the dog being surrendered. The main purpose of LGDR is to ensure that each dog has a chance at finding their forever home. We appreciate and respect the decision you have made to make sure that this can happen. LGDR holds no judgement on owner surrendered pets as unforeseen circumstances happen and challenges do occur. LGDR ensures their best effort to find a loving and safe home for the adoptable pets that are surrendered. The information that you provide to us below assists us in the process of placing the dog into the most compatible home. Filling out this form does not guarantee LGDR will take ownership of the dog. All submissions will be carefully reviewed and LGDR will make the best decision that deems necessary.

If you are more comfortable filling out the paperwork on paper, please view the PDF file below to print.

Once you have completed the physical form, please scan and email to LGDR@littlegiantsrescue.org.

All owner surrender paperwork that is received online will be followed up on within 24 hours.

If this is an emergency surrender, please call us at 630.901.0018.

Surrender Dogs Name: *

Name

Date *

Date

Name *

First Last

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email Address *

Phone Number *

Area Code Phone Number

How do you prefer to be contacted: *

Email Phone Call Text

How long have you cared for this dog? *

Dog's Age

Dog's Breed *

Colors of Dog/Distinctive Markings *

Dogs Gender:

Male Female

Is the dog spayed/neutered?:

Yes-Spayed Yes-Neutered No

Is the dog microchipped?:

Yes No Unsure

Is the dog up to date on vaccines?:

Yes No Unsure

Are you able to provide vet paperwork?:

Yes No

Does the dog have anxiety with car rides?:

Yes No Unsure

If yes to the above question, please explain:

Does the dog have any issues while going on walks?:

Yes No Unsure

If yes to the above question, please explain:

Where did you first get the dog from?

Reason behind relinquishing ownership? *

When was the last time the dog was seen by a Veterinarian, and what Veterinarian was the dog seen by? Please list name, address, and phone number

Please list any major medical conditions that we should know about and/or medications the dog is currently on:

How does the dog respond to visitors and/or strangers?

Has this dog ever tried to cause harm or bite a person? *

Yes No Unsure

If yes, please explain:

Please explain any behavioral issues this dog exhibits: (chewing, barking , digging, food/toy aggression, etc?)

Has this dog lived with other animals?

Yes No Unsure

If yes, please list what types of animals and how many:

Has this dog ever harmed or tried to harm another animal? *

Yes No Unsure

If yes, please explain:

Good with Dogs? *

Yes No Unsure

Good with Cats? *

Yes No Unsure

Good with Children? *

Yes No Unsure

What ages of children has this dog been around? (Select all that apply)

Newborn/Baby (0-12 months) Toddler (1-3 Years) Preschooler (3-5 Years) Gradeschooler (5-12 Years) Teen (13-18 Years)

Please list 3 positive personality traits about this dog:

Is this dog house trained? *

Yes No Unsure

If no, please explain how often the animal has accidents:

Does this dog have a cue if they need to go outside to the bathroom? *

Yes No Unsure

If yes, please explain what the animal does:

Where does this dog spend its time when left alone? *

Inside Outside Both

Is this dog crate trained? *

Yes No Unsure

If outside, how was the dog confined to your property?

Fence Chain Pen/Kennel Loose

If fenced, how tall was the fence?

Has this dog ever tried to escape? *

Yes No Unsure

Where does the dog spend time when you are home?:

Can this animal be left alone inside without incident? *

Yes No Unsure

Please explain any destructive incidents?:

Has this dog ever been to obedience training? *

Yes No Unsure

If yes, do what extent?:

Please list 3 places this dog has been besides your home (ex:dog park, vet, store,etc?:

Please inform us about any special toys or food preferences the dog has:

To the best of my knowledge, all information about the animal given by me to Little Giants Dog Rescue is accurate and true. I understand and hereby certify that (1) I am the true and rightful owner of the animal that I am surrendering on this day to LIttle Giants Dog Rescue, (2) no other individual has any right of property in such animal and (3) I am conveying full and complete rights, title and interest of the animal to Little Giants Dog Rescue.

Little Giants Dog Rescue does not charge a surrender fee, however we ask that you consider making a donation towards the cost of the animal's care and needs.

Fee/Donation

USD

Date *

Date

Signature of Owner Surrender *