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Online Dog Surrender Form
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Owner Name (First, Last):
*
Current Street Address (proof of residency must be shown, if the address entered here does not match driver license or other form of approved valid identification surrender request may be denied as we only serve Cedar Hill, DeSoto, and Duncanville)
*
Phone Number:
*
Email Address:
*
Reason for pet surrender (please provide detailed information)
*
Have you tried looking into help for the reason of surrender?
*
Yes
No
I request additional assistance on keeping my pet and would like Tri-City to contact me for more options
Please fill out the following in as much detail as possible. Accurate and detailed information can help us make the best match possible between your pet and family or rescue group.
Pet's Name:
*
Breed (if unsure list what you think it may be mixed with)
*
Pet's gender:
*
Male
Female
Pet's age (use your best estimate)
*
Is your pet fixed (sterilized/ altered)?
*
Yes
No
Unsure
If your pet has been fixed (sterilized/ altered), which clinic?
Where did you get your pet?
*
This shelter
Another shelter
Breeder
Pet shop
Friend/ Relative
Found/ Stray
Born at home
Rescue group
If you received your pet from another shelter or rescue group, what is the name of the group or shelter?
How long have you had your pet?
*
Where does your pet stay the majority of it's time?
*
Inside house
Fenced yard
Patio
Unfenced yard
Other
If other, please explain
Is your yard fenced?
*
Yes
No
I live in an apartment or living complex that does not have a yard provided
How high is the fence?
What is the fence made of (if unsure use best guess)?
What is the condition of the fence?
If yard is not fenced, how is pet confined outside?
*
How many hours is the dog kept outside?
*
How many hours is the dog kept inside?
*
Where do you leave the pet when no one is home?
*
How many hours a day does the dog spend unsupervised?
*
How does your pet react to that time alone?
*
Where does the pet sleep?
*
Owner's room
Free roam of house
Crate
Doghouse
Garage
Other
If other, where?
What age group has the pet lived with? Select all that apply.
*
Adult Men
Adult Women
Seniors
Children under 10
Children under 16
How would you describe your pet around children? Check all that apply.
*
Friendly
Playful
Tolerant
Afraid
Snappy
Too much for small children
Never been with children
Other
If other, please explain:
How does your pet react to strangers? Check all that apply.
*
Overprotective
Anxious
Fine
Other
If other, please explain.
Does your pet have any fears? Check all that apply.
*
Being alone
Thunderstorms
Men
Women
Children
Loud noises
Hands
Feet
Large vehicles
Appliances
None
Other
If other, please explain:
Does your pet have any negative behaviors? Check all that apply.
*
Chews objects
Digs
Food possessive
Toy possessive
Jumps fencing
None
Other
If other, please explain:
Does your pet have any positive behaviors? Check all that apply.
*
House trained
Rides in cars well
Leash trained
Crate trained
Obedience trained
None
Other
If other, please explain:
Does your pet know these basic commands?
*
Sit
Stay
Down
Off
Come
Leave it
Drop t
Go to your crate/ bed
None
Other
If other, please explain:
If your pet is not house trained, when does he/she have accidents, and how often?
How does your pet ask to go outside?
*
Do you supervise when pet is outside during that time?
*
Yes
No
Does your pet escape?
*
Yes
No
Has your dog repeatedly escape from the yard?
*
Yes, all the time
Yes, when alone
No
If so, how? Check all that apply.
*
Front door
Backyard
Digs
Climbs fence
Jumps fence
Hole in fencing
Does not escape
Other
If other, please explain:
Has your pet been with other animals?
*
Yes
No
Does the dog get along with other animals such as? Check all that apply.
*
Birds
Dogs (male)
Dogs (female)
Cats (indoor)
Cats (outdoor)
Poultry/ Livestock
None
Other
If other, please explain:
Was your dog the leader of the group?
What types of animals does the dog not get along with?
*
Has your pet shown any signs of aggression? Check all that apply.
*
Growls
Snaps
Lunges
None
Other
If other, please explain:
If pet has shown signs of aggression, what was the reason?
For any negative or aggressive behavior have you attempted training or had the dog examined?
Yes
No
Does your pet enjoy being groomed?
*
Yes
No
Has never been groomed
Does your pet tolerate having his/her nails clipped?
*
Yes
No
Has never had nails clipped
Does your pet have any likes?
*
Does your pet have any dislikes?
*
Does your pet have any special needs?
How often do you walk your dog?
*
Health Info
Does your pet have any old injuries or health problems? If yes, please explain.
*
Does your pet have any current health problems? If yes, please explain.
*
Is your pet currently on medications? If yes, please list the medications.
*
Has your pet had flea prevention medication within the past 30 days?
*
Yes
No
Has your pet had heartworm prevention within the past 30 days?
*
Yes
No
What type/brand of food does your pet eat?
*
When was the dog usually fed?
*
AM
PM
Free fed
How much kibble is the dog usually fed at a feeding?
Any other information you’d like to provide?
Do you own any other animals? Check all that apply.
*
Dog(s)
Cat(s)
Other
None
Veterinarian name or clinic name
Date of last visit/ shots
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