Surrender Application

Please read the Surrender Guidelines prior to completing this application. Please answer the questions honestly and be as detailed as possible. This will help is in determining if we will be able to accept your dog in to our rescue.  Please note that shelter dogs in need will take precedence over any owner surrendered dog. Due to the lack of foster home, in most cases, you will be required to “foster” your dog until a home can be found.

This information MUST be submitted along with a photograph before we will consider accepting your dog in to our program. Upon completing the below information, IMMEDIATELY email a picture of your dog to our INTAKE COORDINATOR.

No further action is required.  As a 100% volunteer organization, we will contact you as soon as possible, usually within 48 hours. However, depending on the volume of applications we receive, it may take longer for us to respond to you. We appreciate your patience and understanding. In addition to our organization, we encourage you to seek other avenues to rehome your dog.

Please apply to by filling out the form below

Areas marked with * are required.

How did you hear about us? *

If "Other" please specify

Your Name *

Address: Street *

Address: City *

Address: State *

Address: ZIP Code *

Preferred method of contact *
PhoneEmail

Primary Phone Number (please include area code) *

Primary Phone Type *
HomeCellWork

Secondary Phone Number (please include area code)

Secondary Phone Type
HomeCellWork

Alternative Phone Number (please include area code)

Alternative Phone Type
HomeCellWork

Best time to call *
AnytimeMorningAfternoonEvening

Email address

Dog name *

AKC name

AKC number

Dog birthdate

How did you get the dog originally?*

When did you get the dog originally?

If from a breeder, have you contacted them?*
YesNoNot applicable

Why do you need to re-home your German Shepherd*

When does the dog need to leave your home?*

Are you willing to foster the dog after legally relinquishing the dog to us until a permanent home can be found?*
YesNo

Dog Gender*
MaleFemale

Dog color*

Dog weight*

Dog tattoo

Dog micro-chip (make & number)

Dog identifying marks (scars, broken teeth, etc)*

Dog general overall appearance*

Dog likes
DogsCatsOther Small AnimalsChildrenStrangersVisit to VetCrateCar RidesToys and PlayWaterBeing GroomedTravelingRunning/JoggingLike Walks

Dog dislikes or habits
Dog AggressionFood AggressionToy AggressionFence JumpingEscapes YardDiggingSeparation AnxietyChewingBarking when left unattendedDestructiveScared of Thunder Storms

Dog other fears or dislikes

Dog other aggressions

Dog temperament towards people
FriendlyShyCautiousOutgoingHyperEnergeticCalmAnxiousDominantSubmissiveSubmissive PeeingObedientChallenging

Dog temperament towards other dogs
FriendlyShyCautiousOutgoingHyperEnergeticCalmAnxiousDominantSubmissiveObedientChallenging

Has the dog ever bitten a human? *
YesNo

If yes, describe

Has the dog ever nipped/shown aggression towards a human? *
YesNo

If yes, describe

Has the dog ever had formal training? *
YesNo

If yes, describe

Has the dog been crate trained? *
YesNo

Describe any behavior

What is the dogs energy level? *
Very LowLowAverageHighVery High

Dog history
House DogHouse BrokenOutdoor DogTied UpContained in Open YardSleeps InsideSleeps in GarageAbusedNeglected in any wayHit by a carBredAllowed on the furnitureAllowed Off the leash in NON fenced areaAttacked by another animalKenneledUsed to wearing a collar

How does this dog signal to go outside

What words or commands does this dog know

Veterinarian name

Veterinarian phone

Veterinarian address

Veterinarian - date of last visit

Date of DHPP

Date of Rabies

Date of Bordetella

Date of Heart Worm

Heart Worm results
UnknownPositiveNegative

Preventative brand

Is the dog spayed/neutured? *
YesNoDon't know

Dog Allergies?

Dog Medical Problems?

Dog medications required?

Describe any past surgeries

Describe any past emergency care

Describe current dog food *

Describe feeding schedule and quantity *

Items you are sending with the dog
ToysCrate/BedFoodCollar with TagsLeashMedicationOther

If "Other" please specify

Is there anything else we should know about the dog?

Human check (required)