Apply To Surrender A Dog

    1. Your Information

    Select State/Province
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia American Samoa Guam Northern Mariana Islands Puerto Rico United States Minor Outlying Islands Virgin Islands, U.S.

    2. Dogs Information

    Gender
    Male Female
    Spayed/Neutered?
    Select an option
    No Yes
    Date last vaccine

    3. History

    When did you get the dog?
    How did you get the dog?
    Select an option
    Puppy of current dog Shelter Breeder Stray Given to me Other
    How many homes has this dog had?
    Select an option
    1 2 3 More
    Why are you giving up the dog?
    Select that apply
    Dog’s health issues My health issues Found as stray New baby No time/Not at home enough Behavior issues Moving and cannot take dog Allergies Cannot afford care Other