Surrender Profile

Please read our surrender page before filling out the application


Your Name:

Phone Number:

Email Address:


Dog Information    (Please attach a photo of your dog)

Dog’s name:





Approx. weight:



Dog’s History
1. Please describe your reasons for wanting/needing to surrender your dog:

2. How long has this dog lived with you?

3. Where did you obtain this dog?


Dog’s Health

1. Is your dog current on vaccinations?

2. Is your dog microchipped?    If so, what company?

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

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

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


Housetraining and Yard Habits

1. Where does your dog spend the day?

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

3. Where does your dog spend the night?

4. What is your dog’s exercise routine?

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

a. If yes, please describe when/why you use the crate and their behavior in the crate:

6. Is your dog potty trained?

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?

7. Do you have a fenced in yard?

a. If so, what is the height and type of fencing:

b. Has your dog ever escaped from the yard or house?

i. If yes, please explain the circumstances:


Your Dog’s Favorite Things

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

2. Does your dog enjoy meeting and/or playing with other dogs?

a. If yes, 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. Who is your dog’s favorite company?

5. How does your dog show affection?


Your Dog’s Social Skills

1. How does your dog greet strangers in the home?

2. How does your dog greet strangers outside of the home?

3. Has your dog had any experience with children?

a. If yes please describe the level of interaction and the dog’s reaction:

4. How does your dog react around other dogs outside of the home?

5. Has your dog lived with other dogs? and/or cats?

a. If so was the situation successful?

b. If not, please explain why:

6. Has your dog ever fought with another dog?

a. If yes please describe the situation:

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

7. 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
      • Bruise or scrape
      • 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
      • How does your dog behave at the veterinarian?

8. How does your dog behave for bathing?

9. How does your dog behave for nail trims?

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

a. If so, please explain their reaction:


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 behaviors such as excessive chewing, barking, separation anxiety, digging, etc.?

a. If yes, please explain:

b. Under what circumstances does the dog exhibit these behaviors?

c. Where does the dog exhibit these behaviors?

d. Please explain frequency that your dog displays these behaviors:


Your Dog’s Fears

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

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


Aggression Tendencies

1. Has your dog ever bared its teeth, growled, lunged, or snapped at your or anyone else?

a. If yes, explain the circumstances:

2. Has your dog ever shown any other form of aggression towards you or anyone else?

a. If yes, explain the circumstances:

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

a. If yes, explain the circumstances:


Please use the space below for any additional information you would like to share with us about your dog.  Please also include a photo of your dog when submitting this profile.


Please note that we currently have a waiting list of dogs needing to come into rescue.  We will do our very best to place your dog into one of our foster homes asap, but space is limited and you may be required to hold onto your dog until a suitable space becomes available.  In the mean time, feel free to contact us for any additional help with your dog while you are waiting.  Thank you, your time and consideration is greatly appreciated.


Hillary Edelen – Intake Director         720-722-1116

Mary Bondoux – Foster Director            720-491-1278