Surrender Profile

Please visit our Surrender Process page for information about the process before filling out the surrender profile.  Please copy and paste the profile below into an email or document, to complete and return to us.  You will get an email confirming that it has been received and letting you know when you can expect to hear from us.  We do our best to respond to owner surrenders within 24 hours, but please understand that we are all volunteers with full time jobs, so your patience is appreciated.  If you have not heard from us in a timely manner, and your situation is urgent PLEASE DO NOT TAKE YOUR DOG TO A SHELTER, call us at 720-491-1278.



Your Name:


Phone Number:

Email Address:

Dog Information:    (Please attach a photo of your dog)

Dog’s name:


Age or Birthdate (if known):


Approx. weight:


Is your dog a pure bred Shiba? If mixed, what is the other breed(s)?

Dog’s History:  Please know that the more honest and forthcoming you are about your reasons for surrendering and your dog’s history/health/behavior (no matter how bad), the better able we are to help you, and your dog.

1. Please describe in detail your reasons for surrendering your dog:

2. How long has this dog lived with you?

3. Where did you obtain this dog?

4. If you are not the dog’s first owner, do you know anything about their history?

Dog’s Health:

1. Is your dog current on vaccinations?

2. Is your dog microchipped?  (Please provide microchip number if known)

3. What is the name and phone number of your veterinarian?

4. Does your dog have any medical concerns, currently taking medication, or have any special needs?

5. What brand & flavor of food are you currently feeding your dog?

Dog’s Environment/Lifestyle:

1. Describe your dog’s current living environment (house with a yard, apartment/condo with no outdoor space, etc.)

a. If you feel the current environment is not ideal, please describe an environment you believe they would thrive in:

2. Where does your dog spend the day? (loose in the house, crated, goes to work with you, etc.)

3. For how many hours is your dog left at home alone?

4. Where does your dog sleep at night?

5. Is your dog crate trained and are you currently using the crate on a regular basis?

6. What is your dog’s exercise routine?

7. Is your dog house trained? (meaning only goes outside, not on pee pads or fake grass matts)

a. How does he/she let you know they need to go outside?

b. If your dog is not potty trained, under what circumstances might he/she have an accident?

8. Do you have a fenced in yard?

a. What is the height and type of fencing:

b. Has your dog has ever escaped from the yard? Please describe the circumstances:

c.  Is your dog a “bolter” (meaning they will bolt out an open door given the opportunity)?

Your Dog’s Social Skills with Pets:

1. Has your dog ever lived with other dogs?

a. Was it successful? If not, why?

2. How does your dog react to other dogs outside the home?

a. Do they get along best with a specific type of dog (breed, size, gender)?

b. Are there specific types of dogs they don’t get along with (breed, size, gender)?

3. Does your dog enjoy the dog park?

4. Has your dog ever fought with another dog?

a. If yes, please describe the situation.

b. Were food, toys, bones, or rawhides involved?

5. Has your dog ever injured another dog?

a. If so, please describe the location and type of injury:

b. How severe was the injury?  (Check all the apply)

      • Couldn’t find anything but saliva
      • Single bite which broke or punctured the skin
      • Multiple bites which broke or punctured the skin
      • Severe multiple punctures and/or tearing of the skin

6. Does your dog currently, or have they ever lived with cats?

a. Was it successful? If not, why?

Your Dog’s Social Skills with People:

1. Does your dog currently, or have they ever lived with children?

a. How old were the children?

b. Was it successful? If not, why?

2. If your dog has not lived with children, have they had any experience with children?

a. Please describe the level of interaction and the dog’s reaction:

3. How does your dog react to strangers in the home?

4. How does your dog react to strangers outside of the home?

5. Has your dog ever shown any form of aggression (bared it’s teeth, growled, lunged, or snapped) towards you, or anyone else?

a. If yes, explain the circumstances:

6. Has your dog ever bitten and broken the skin on you, or anyone else?

a. If yes, explain the circumstances:

Your Dog’s Behavior/Training:

1. Has your dog been through any professional obedience training?

a. If yes, please describe:

2. What commands does your dog know?

3. Does your dog display any destructive or problematic behaviors (i.e. excessive chewing, barking, separation anxiety, digging, etc.)

a. If yes, please describe the behavior and the circumstances under which they display the behavior(s):

4.How does your dog behave at the veterinarian?

5. How does your dog behave for bathing?

6. How does your dog behave for nail trims?

7. Is your dog sensitive about being handled in any way?

a. If so, please explain their reaction:

8. Who is your dog’s favorite company?

9. What is your dog’s favorite game/activity/toys?

10. How does your dog show, or ask for affection?

11. Does your dog have any fears, and if so what are they?

a. What does your dog do when they are frightened?

Please use the space below for any additional information you would like to share with us about your dog:  


Please email the surrender profile to:   If you have any questions, or are unsure if you want to surrender your dog, and just want some advice, please call 720-491-1278.

**Please note that we often have a waiting list of dogs needing to come into rescue.  We do our best to place your dog into one of our foster homes as quickly as we can, but space is limited, and you may need to keep your dog until a suitable space becomes available.  In the mean time, we can offer you tips and advice to help you deal with any issues you may be experiencing with your dog.  Your patience is greatly appreciated.