Owner Surrender Information

Must be minimum 10 years of age (adjusted by breed)
Must be current on rabies, distemper, and kennel cough vaccines
Must have a current heartworm test and a recent (within 2 weeks) fecal test
Send completed “Owner Surrender” form along with veterinary records and current photograph(s) of the dog(s)  to

Please complete the surrender form below. If you wish to download a paper copy and send it to us instead, you can do so  here.


Organization Seeking to Transfer a Senior Dog?
Please contact our Program Coordinator for more information

Surrender Form

House dogOutside dogBoth

Please attach copies of all vet records including rabies certificate signed by veterinarian


(Owner’s initials)

Barks/Howls/WhinesDumps TrashDigsJump on PeopleMark its TerritoryRoams

Handles StepsWalk on LeashCrate TrainedRides Well in CarTears Furniture/Carpet

BicyclesCatsChildrenFirecrackersLoud NoisesMotor VehiclesPassing CarsReact to UniformsStormsStrangersVacuums

ActiveAggressiveDestructiveEasy GoingFriendlyNervousNeuroticReservedShyStubbornNoisyObedientOne Person DogPlayfulProtectiveQuiet

Baby to 5 yrs5-910-13Older




FriendPet ShopGiftStrayBreederAnimal ShelterAbandonedOther


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