Dog Surrender Application Form Start the Surrendering Process Today

We want to make sure that we have the best fit for our foster and furever homes and rescue dogs, filling out the form below will help us match the rescue dog with a family’s lifestyle and what they are looking for in a pet.

Please check out our Dog Surrender Application Process page for detailed information on our process and eligibility before filling out the form.

To note, we respect your privacy and do not tolerate spam. We will never sell or give away your information (name, address, email, etc.) to any third party. All information on this form is kept confidential between our directors and volunteers. We may discuss pet history with your veterinary hospital if applicable.

The Surrendering Family Contact Information

What's your First Name?

Please enter your first name.

What's your Last Name?

Please enter your last name.

What’s your Email?

Please enter a valid email address.

What Phone Number can we reach you at?

Please enter your phone number.

What Type of Phone is that number?

HomeCellWork Please let us know what type of phone number you've entered.

When is the Best Time to Call that number?

Please let us know the best time to call the phone number provided.

Is there an Alternate Phone Number we should take note of?

YesNo Please let us know if there is another phone number to reach you at.

What’s the Alternate Phone Number?

Please enter your alternate phone number.

What Type of Phone is that number?

HomeCellWork Please let us know what type of alternate phone number you've entered.

When is the Best Time to Call that number?

Please let us know the best time to call the alternate phone number provided.

What’s your Home Address?

Street Address

Please enter your street number and name,

City, Town or Village

Please enter your city.

Province

Please enter your province.

Postal Code

Please enter your postal code.

Do you have a Spouse/Partner?

YesNo Please let us know if you have a spouse/partner.

What's your Spouse/Partner’s First Name

Please enter your spouse/partner's first name.

What's your Spouse/Partner’s Last Name

Please enter your spouse/partner's last name.

About the Dog Being Surrendered

Why have you Chosen to Surrender your pet?

Please let us know why you have chosen to surrender your pet.

From where/who did you Get Him or Her? Please provide breeder contact info if applicable.

Please let us know from where/who did you got the dog, including the breeder's contact info if applicable.

How long have you Owned the Dog?

Please let us know how long you have owned the dog.

What’s the Dog’s Name?

Please let us know the dog's name.

What’s the Dog’s Date of Birth?

Please let us know the dog's date of birth or its age.

What’s the Dog’s Breed?

Please let us know the dog's breed.

What’s the Dog’s Gender?

MaleFemale Please let us know your gender preference.

Is the dog Spayed/Neutered?

YesNo Please let us know if the dog has been spayed/neutered.

Where is the dog Used to Sleep at Night?

Please let us know where the dog is used to sleep at night.

Where is the dog Used to Be Kept When You Leave the House?

Please let us know where the dog is used to be kept when you leave the house.

Is the dog Housebroken?

YesNoPartially Please let us know is the dog is housebroken.

Is the dog Crate Trained?

YesNo Please let us know if the dog is crate trained.

Is the dog Destructive When Left Alone?

AlwaysSometimesNever Please let us know if the dog is destructive when left alone.

Does the dog Do Any of the Following When Left Alone? (check all that apply)

BarkChew FurnitureChew Personal Items (e.g. shoes, clothing, etc.)Scratch Doors or Window SillUrinate in the HouseDefecate in the HouseNo Notable Behaviour(s)Other Behaviour(s) Please let us know what the dog does when left alone.

Please describe what Other Behaviour(s) the dog does:

Please describe what other behaviour the dog does when left alone.

How is the Dog Usually Left Outside? (check all that apply)

Please describe How the Dog is Usually Left Outside:

Please let us know how the dog was left outside.

Does the dog Do Any of the Following When Left Outside Unsupervised? (check all that apply)

Please describe What the Dog Does When Left Outside Unsupervised:

Please let us know how the dog behaved when left outside.

Has the dog Been Consistently Around Children?

YesNo Please let us know if the dog has been consistently around children.

Please list the Children's Age(s) the dog is used to be around?

Please let us know the children's age(s) the dog is used to be around.

Is the dog Rough or Gentle When Playing With Kids, please describe a usual interaction?

Please let us know if the dog is rough or gentle when playing with kids, please describe a usual interaction.

Have the dog’s Experiences With Children Always Been Positive?

YesNoOther Please let us know if the dog’s experiences with children always been positive.

Please Explain:

Please let us know how the dog's experiences with children is not always positive,

Has the dog Ever Bit a Person for any reason?
(Please know that this question does not necessarily determine the outcome of the dog)

YesNo Please let us know if the some has ever bit someone.

Please Describe the Circumstances:

Please provide the fence requested details.

Has the dog Ever Lived With Cats?

YesNoDon’t know Please let us know if the dog has ever lived with cats.

Does the dog Like Cats?

Yes NoDon't Know Please let us know if the dog likes cats.

Has the dog Ever Hurt a Cat?

YesNo Please let us know if the dog has ever hurt a cat.

Please Explain the Situation

Please describe the situation when the hurt a cat.

Is the dog the Only Dog In the Household?

YesNo Please let us know if the dog is the only one in the household.

Please List the Other Dog(s) including their age, sexe & size:

Please list the other dogs in the household.

Does the dog Get Along With Other Dogs?

AlwaysUsuallySometimesNever Unsure (has never been around dogs) Please let us know if the dog gets along with other dogs.

Has the dog Ever Been in a Dog Fight in which either dog was injured?

YesNo Please let us know if the dog has ever been in a dog fight in which either dog was injured.

Please Explain the Situation

Please explain the situation when the dog fight with injuries occurred.

What is the dog’s Reaction When New Visitors Enter the House?

Please let us know what is the dog’s reaction when new visitors enter the house.

What is the dog’s Reaction When You Take Away a Favorite Toy or Bone?

Please let us know what is the dog’s reaction when you take a favorite item from them.

What is the dog’s Reaction When You Take Away Their Food?

Please let us know what is the dog’s reaction when you take a food from them.

What is the dog’s Reaction When They’re Disturbed When Sleeping in their favorite spot?

Please let us know what is the dog’s reaction when you disturb them from sleep in their favorite spot.

What Type of People does the dog feel Most Comfortable With? (check all that apply)

Will the dog Let You Groom It?

YesNoUnsure Please let us know if the dog will let you groom it.

Will the dog Let You Clip Its Nails?

YesNoUnsure Please let us know if the dog will let you clip its nails.

Does the dog have Behavioral Problems?

YesNoUnsure Please let us know if the dog has behavioral problems.

Please Describe/Explain:

Please describe/explain the dogs behavioural problems

What are Two(2) Things you Like Most About the Dog's Behaviour?

Please let us know what are two(2) things you like most about the dog's behaviour.

What are Two(2) Things you Dislike About the Dog's Behaviour?

Please let us know what are two(2) things you dislike most about the dog's behaviour.

Are all Members of Your Household Aware that you are surrendering the dog into the rescue group’s care?

YesNoIt’s complicated Please let us know if all family members are aware that the dog is being surrendered.

Please Explain:

Please explain the situation with the household and awareness of the dog being surrendered.

What would Have to Happen for You to Keep the Dog?

Please let us know what would have to happen for you to keep the dog.

Do you Accept the Mandatory Surrender Fee to relinquish your dog to our rescue group of $80 for unneutered/unspayed dogs and $40 for neutered/spayed dogs?

YesNo Please confirm that you accept the mandatory surrender fee.

Health & Veterinary Reference

Does the dog have Any Medical Problems?

YesNo Please let us know if the dog has any medical problems.

Please Describe:

Please describe the dog's medical problem(s).

Is the dog On Any Medications?

YesNo Please let us know if the dog takes any medications.

Please Describe:

Please describe the medications the dog takes.

When was the dog’s Last Vaccination & Rabies Shot?

Please let us know when was the dog's last vaccination & rabies shot.

Which Veterinary Clinic looks/looked after of your current or past pets?

Clinic’s Name

Please let us know the name of the veterinary clinic's that looks/looked after of your current or past pets.

Clinic's Phone

Please let us know the phone number of the veterinary clinic's that looks/looked after of your current or past pets.

Veterinarian's Name

Please let us know the name of the veterinarian at the clinic's that looks/looked after of your current or past pets.

Please confirm that you will call your vet as soon as possible to give them permission to speak to "Fulfilling Hearts Rescue" regarding your pets. If we call and they advise that you have not contacted them to release the information we require, your application will NOT be processed.

Yes, I confirm I will call my vet to give permissionNo, I will not call my vet Please confirm that you will be calling your vet to give permission.

By submitting this application, you confirm that the information provided on this form is true and correct. You further understand that by providing this information, Fulfilling Hearts Rescue is under no obligation to accept your dog.

You understand that you will no longer have ownership rights whatsoever to the above named dog once under Fulfilling Hearts Rescue’s care.

In addition, you understand that said dog will be rehomed to an appropriate family based on the rescue group’s best judgment. You do not have any say or objection towards where the above mentioned dog will end up. You also agree that you are not to attempt to contact the dog’s new adoptive family without permission from the directors of Fulfilling Hearts Rescue. You understand that appropriate legal measures may be taken to protect the new adoptive family if necessary.

Finally, you have hereby decided to surrender complete care and control of your dog listed above to Fulfilling Hearts Rescue

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Dog Surrender Application Form Start the Surrendering Process Today

The Surrendering Family Contact Information

About the Dog Being Surrendered

Health & Veterinary Reference

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