No Paw Left Behind

No Paw Left Behind - Canine Surrender Application

Thank you for contacting No Paw Left Behind. Please complete the following surrender application.
There are no "right" and "wrong" answers; our goal is to learn more about your pet and to ensure the best possible match is made for the adopter and the dog. Our decisions are made based on our knowledge of the rescued dog's background and temperament.
The application must be complete, to be considered and will be kept confidential.
PLEASE NOTE THAT ANY DOG ACCEPTED AS AN OWNER SURRENDER WILL BECOME THE PROPERTY OF NO PAW LEFT BEHIND AND THE SURRENDERER WILL WAIVE ALL OWNERSHIP AND RIGHTS TO THE PET.

Name of dog you would like to surrender *
Sum up this pet in one sentance *
Please explain the reasons why you are looking to surrender this pet, including how long you have had the pet, where you attained the pet and your overall living sitaution with the pet. Please also list behavioral issues including bite or aggression history.
Applicant Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone Number * ### - ### - ####
Age *
Are you applying the Primary Caretaker of the pet? Yes or No, if No please explain: *
Have all members of the household agreed to surrender the pet? *
Any children in the home? If so how many and what ages? (We are interested to know if the pet has been around children) *
Please list household members:
Name/relation/age/occupation
Does anyone in your household have an allergy to animal hair or dander? *
Yes No
If Yes please explain:
Home information:
Do you live in
*
Condo Apartment House Mobile Home Townhouse Other
If Other please explain:
Has this pet been around a pool or body of water? *
Yes No
How does this pet react to water?
Do you have a private yard? *
Yes No
Is the yard fenced in? If so, by what type and what height? *
Has your pet been socialized around other pets? *
Have you ever relinquished a pet to a rescue or shelter? If yes, where, when and why? *
Have you ever re-homed a pet? If yes, where, when and why? *
Is your pet up to date with vaccinations? (Answering honestly to the following will not result in an immediate rejection of your application) *
Yes No
Is your pet on heartworm preventative? (Answering honestly to the following will not result in an immediate rejection of your application) *
Yes No
Is your pet on flea and tick prevention? (Answering honestly to the following will not result in an immediate rejection of your application) *
Yes No
Is your pet spayed or neutered? (Answering honestly to the following will not result in an immediate rejection of your application) *
Yes No
Please list the name of your veterinarian * First Last
The name of your vet office *
Vet Office Phone Number * ### - ### - ####
Has your pet had any type of training? If so what type? *
Do you consider any of your pet's behavior to be unacceptable? *
What is your pet's normal eating and exercise schedule? *
Are you able to make a donation to the care of your pet while in our foster network? We suggest $50-$100 to help us cover medical testing and basic care. *
I agree I do not agree
Do you agree to disclose all medical information as well as behavior information upon surrendering your pet? *
I agree I do not agree
Do you agree to disclose any and ALL information regarding bite or aggression history? *
I agree I do not agree
Are you interested in any volunteer opportunities (foster, online, phone, transport, events)? If so please describe:
By typing you name into this field you are agreeing that all information in this application is truthful to the best of your ability. * First Last
Do Not Fill This Out