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Animal Surrender Form

Owner Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Enter Email Confirm Email

Phone(Required)

Dog's Information

Dog's Name(Required)

Dog's Age(Required)

Dog's Weight(Required)

How long have you had this dog?(Required)

Dog's Gender(Required)

Male

Female

Is dog spayed/neutered?(Required)

Yes

No

Unknown

What items will you be sending with the dog?(Required)

Food

Crate

Leash

Collar

Harness

Heartworm preventative

Flea & Tick preventative

Medications

Other Items

Please list any other items you'd like to include with your dog

Consent(Required)

I agree

By signing this form, I state that I am the owner of the animal(s), who is/are the subject of this Animal Surrender Form, hereinafter referred to as “the animal.” To my knowledge, no other person has any rights to this animal. I hereby surrender all rights to the animal to Doodle Rock Rescue. I understand that once I relinquish the animal, the animal will not be available to be returned. I have read and understand the terms of this Animal Surrender Form.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

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