Dog Surrender Application - Pet Haven of Minnesota

Before you fill out this form...*

Due to the high volume of requests we are currently receiving, we cannot provide immediate surrender services. Minnesota pets and people are in crisis. As a result we are seeing an increase in demand. This has resulted in longer processing times. Please be patient while we work through all the requests. We are doing our best but it may take up to a week to hear back from us. We are a foster based organization meaning we are not able to take your pet till a foster is open. It’s also possible we may not be able to find placement. Please understand we are doing our best and please consider keeping your pet if at all possible. Thank you for your patience and understanding. In addition to Pet Haven, we urge you to network your animal within your personal contacts as well as other rescues. Also review our Resources Page on our website as there maybe other available resources that can help. Do you still want to continue?

Date*

Your Name*

First Last

City*

State*

Phone*

Email*

What is your dog's name?*

Did you adopt your dog from Pet Haven?*

Yes
No

If you adopted from Pet Haven, when did the adoption take place?

Where did you get your dog?*

How long have you owned your dog?*

What breed is your dog?*

How much does your dog weigh?*

What age is your dog?*

What is your dog's gender?*

Male, neutered
Male, not neutered
Female, spayed
Female, not spayed

Why are you surrendering?*

Please briefly explain why you are looking to surrender your dog.

How long are you able to continue to house your dog?*

Behavior Questions

Does your dog have potty accidents in the house?*

Yes
No

How often do the accidents happen?

How long can your dog "hold it"?*

On a typical day, how many hours is your dog left alone in the home without any people there?*

Is your dog crated when you are away from the home?*

Yes
No

Does your dog ever choose to go in the crate on their own?

Yes
No

How much time does your dog spend in the crate each day?

Does your dog do any of the following inside the crate?

Please check all that apply.

Defacate
Urinate
Destroy bedding/items in crate
None of the above
N/A - My dog isn't crated.

When left alone where is your dog located?*

When alone does your dog do any of the following?*

Please check all that apply.

Damage household items
Urinate
Defecate
Bark Frequently
Cry Frequently
None of the above

If your dog is not crated when left alone, do they destroy household items or go to the bathroom indoors?

Yes
No

Does your dog currently live in the same household with (check all that apply)

Another dog/dogs
A cat/cats
A child/children
Another type of animal

If your dog currently lives with another dog(s) in the home please list the other dog's age, size and sex.

Please describe the relationship dynamics between the dogs in the home

When your dog first encounters another dog they've never met before, for example on a walk, in a park or when a friend brings their dog over to your home, how does your dog react?*

Examples of reactions would be sniffing, barking, lunging, ignoring, unsure, etc.

Have you noticed that your dog has certain dog/dog preferences?*

For example, they don't like small dogs, female dogs, etc.

If your dog currently lives with a cat in the home please describe the confidence level of your cat when around dogs; for example, will they stand their ground and hiss/swat if the dog is being too much or do they run and hide from the dog?

Please describe the relationship dynamics between the dog and cat

Has your dog ever met a cat outside your home? If so, please describe what that interaction(s) was like.

Examples of reactions would be sniffing, barking, lunging, ignoring, unsure, etc.

If your dog currently lives with a child(ren) in the home what is the chil(ren's) age(s)

Please describe the typical interactions/relationship dynamics of the dog with the child(ren) in the home.

Does your dog regularly interact with any children outside your home? If so, how often are the interactions, what are the ages of the kids, and what do those interactions look like?

When you have a new guest come visit your household, how does your dog tend to react to that new person?*

When you go for walks and/or out into the community with your dog and you encounter strangers, how does your dog tend to react to them?*

When you walk your dog on leash, what tools do you use (examples include collar, front clip harness, back clip harness, gentle leader, prong collar, slip lead, etc)?*

Does your dog walk with a loose leash, besides you? Or do they walk in front of you and pull?*

Has your dog ever jumped a fence and if so, what type of fence (chain link, privacy, etc)?*

Please include how tall the fence was too.

Are there areas on the dog’s body your dog does NOT like to be touched?

Please check all that apply.

Ears
Mouth
Tail
Collar
Rear End
Paws/Nails
No Issues
Other

If touched in any of the above places how does your dog respond?

Please check all that apply.

Moves away
Shows teeth
Growls
Snaps
Bites
No reaction
Doesn't react negatively when touched anywhere
Other

Resource guarding occurs when dogs exhibit behaviors like growling, lunging, or biting over something they hold a high value to. Has your dog ever resource guarded?*

Yes
No

What has your dog resource guarded?

Check all that apply

Has your dog ever bitten a person?*

Pet Haven works to help investigate why a bite has happened and what can be done to avoid it in the future.

Yes
No

If your dog has bitten a person, please describe the bite(s) in as much detail as possible.

Has a professional trainer ever worked with your dog?*

Yes
No

What is the name of the training company used?

What commands does your dog understand?

Sit
Stay
Leave it
Come
Down
Place
Kennel/Crate

What food is your dog currently eating? (Please be specific - Brand Name, Type, Small/Large Breed, Dry/Canned, etc.)*

Ex: Purina Pro Plan Chicken and Rice Small Breed, Dry

Does your dog have any food sensitivities?*

Ex: Chicken causes hives, peanut butter causes allergies

Medical History

Has your dog been spayed or neutered?*

Yes
No
I don't know

Has your dog ever had surgery?*

Ex: Dental, amputation, bladder stones

Yes
No
I don't know

Surgery Details

Please explain.

Has your dog been tested for Heartworm in the past 12 months?

Yes (tested negative)
Yes (tested positive)
I don't know

Does your dog currently have any medical needs or have they had any in the past?*

Ex: Seasonal allergies ongoing, bladder stones in 2017, diabetes

Is your dog on any medications?*

Ex: Apoquel (allergy), Prednisone, Vetmedin

How does your dog behave during visits to the vet?*

Ex: Fine/happy, scared but handleable, reactive barking, bites and needs to be muzzled

Please provide your veterinarian's name and phone number (Pet Haven will require records prior to placement).

Is there anything else you would like us to know about your dog that hasn't been covered above?

Are you interested in discussing options other than surrender with a Pet Haven representative (such as training techniques or behavior assistance)?

Yes
No

Social Media Permission*

Our application volume has increased over 300% since 2019 (pre-Covid). As such, it can take us some time to find foster placement. To help speed the process up, we sometimes network dogs seeking foster placement with us on our public social media sites. Do we have your permission to include photos of and information about your pet in these social media communications?

Photos

At least one photo is required to be able to post your pet to our foster base. Including photos of your pet increase the likelihood of finding foster placement and speed up the fostering process. Please attach 1-2 photos of your pet (upload file size limit: 50 MB)

Drop files here or

Max. file size: 50 MB.

Vet Records

Including your pet's vet records increases the likelihood of Pet Haven finding a foster for your dog and speeds up the placement process. Please attach your dog's vet records.

Drop files here or

Max. file size: 50 MB.

You should receive a response from us within 24-48 hours. If you have not received an email, please check your spam folder.

Within 72 hours of clicking the "submit" button below you will receive an email from one of our volunteers, which sometimes goes to the spam/junk folder. Be sure to keep your eye on that part of your email inbox. Please check this box to acknowledge you read this.*

I acknowledge I have read this.

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