Dog Surrender Form Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *County *Email *Government ID #Pet InformationPet's Name *Estimated Age *Estimated Weight *Suspected Breed(s) *Gender *FemaleMaleLitterUnknownSpayed/Neutered? *YesNoUnknownColor *Why are you interested in placing this pet with FHS? *Is the pet housebroken? *YesNoUnknownIs the pet good with dogs? *YesNoUnknownIs the pet good with cats? *YesNoUnknownIs the pet good with children? *YesYes, ages 0-3 yearsYes, ages 4-11 yearsYes, ages 12-18 yearsNoUnknownDoes your pet allow you to hold them? *YesNoUnknownIs your pet vocal? *YesNoIf your pet is vocal, please explain *Do you have any additional notes on your pet that you would like to share? (Personality quirks, any known commands, or fears?) *Medical InformationName of Veterinary Clinic *Can you provide medical records for the pet? *YesNoNot sureIs the pet on monthly heart worm prevention? *YesNoNot sureIs the pet current on their Distemper/Parvo vaccine? *YesNoNot sureIs the pet current on their Rabies vaccine? *YesNoNot sureMicrochipped? *YesNoNot sureAny known health issues/medications? *How long have you had your pet? *Has this animal shown any aggression towards any person or another animal? Please explain. *Has the pet ever bitten any people or other animals? (If yes, please explain) *Please upload a photo(s) with this form. We will be unable to process the application without a photo. * Click or drag a file to this area to upload. NameSubmit
