Owner Surrender - Dog - Pet Haven of Minnesota

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Dog's Name*
Did you adopt your dog from Pet Haven?*
- Yes
- No
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
- Female
Why are you surrendering?*
Please briefly explain why you are looking to surrender your dog.
Fostering*
Pet Haven does our best to find fosters for all of the dogs that we can and will always be able to help a dog that was adopted from Pet Haven, but some dogs are more difficult to place and may take days to weeks to find and appropriate and safe foster home for. Some dogs may be easiest fostered by their surrendering owners. Keeping this in mind, how long are you able to continue to house the dog?
Traits & Habits
Are there any wonderful, special traits or habits that you would like his/her new family to know about?
Is your dog housetrained?*
- Yes
- No
Does your dog have accidents in the house?*
- Yes
- No
How often do the accidents happen?*
How long can your dog "hold it"?*
Is your dog crate trained?*
- Yes
- No
Time in Crate*
How much time does your dog spend in the crate each day?
Time Alone*
How long is your dog left alone without people most days?
Location Alone*
When left alone where is your dog located?
- Outdoors
- Free at home
- Confined to a room
- Crated
Behavior Alone*
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
Household Item(s) Damage*
When your dog is alone and damages household items, please check all behaviors that apply.
- Chews windows or doors
- Chews furniture
- Chews clothing or shoes
- Chews toys
- Other
Behavior When at Home*
When you are home does your dog do any of the following? Please check all that apply.
- Damage household items
- Urinate
- Defecate
- Bark Frequently
- Cry Frequently
- No Issues
- Other
Handling*
How does your dog react to handling such as petting, hugging or bathing?
Does your dog get along with other dogs?*
Does your dog get along with cats?*
Does your dog like children?*
Touch Response
If touched in any of the above places how does your dog respond?
- Moves away
- Shows teeth
- Growls
- Snaps
- Bites
- No reaction
- Doesn't react negatively when touched anywhere
- Other
Touch Sensitivity
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
Has your dog ever bitten a person?
- Yes
- No
Bite Details
If your dog has bitten a person, please describe the bite(s).
Is the dog permitted to sit and/or sleep on furniture?
- Yes
- No
Training
Has your dog completed any training? If so, please describe.
Car Behavior
How does your dog behave in the car? Please check all that apply.
- Enjoys
- Afraid
- Resists Entering
- Sleeps
- Barks
- Vomits
- Urinates
- Defecates
- Never Tried
- Fine in a Crate
Commands
What commands does your dog understand?
- Sit
- Stay
- Leave it
- Come
- Down
What are the dog’s favorite kinds of toys?
Behavior when Eating
How does your dog react when you or another family member pet him/her or touch the bowl or food while he/she is eating? Please check all that apply.
- No reaction
- Never tried
- Allows
- Lunges
- Shows teeth
- Growls
- Snaps
- Bites
Behavior when Chewing
How does your dog react when you or another family member pet him/her or touch a bone, rawhide, pig’s ear or other delicious edible while chewing?
- No reaction
- Never tried
- Allows
- Lunges
- Shows teeth
- Growls
- Snaps
- Bites
Behavior when Chewing
How does your dog react when you or another family member pets him/her or touches a stolen food item?
- No reaction
- Never tried
- Allows
- Lunges
- Shows teeth
- Growls
- Snaps
- Bites
Behavior with Stolen Food
How does your dog react when you or another family member pets him/her or touches a stolen food item?
- No reaction
- Never tried
- Allows
- Lunges
- Shows teeth
- Growls
- Snaps
- Bites
Behavior with Toy in Mouth
How does your dog react when you or another family member pets him/her or touches a toy while it's in the dog's mouth?
- No reaction
- Never tried
- Allows
- Lunges
- Shows teeth
- Growls
- Snaps
- Bites
Behavior while Sleeping
How does your dog react when you or another family member pets him/her or moves him/her while sleeping?
- No reaction
- Never tried
- Allows
- Lunges
- Shows teeth
- Growls
- Snaps
- Bites
Behavior when on Furniture
How does your dog react when you or another family member pushes or pulls him/her off of furniture?
- No reaction
- Never tried
- Allows
- Lunges
- Shows teeth
- Growls
- Snaps
- Bites
Behavior around Family Members
How does your dog react when you or another family member approaches him/her while next to another family member?
- No reaction
- Never tried
- Allows
- Lunges
- Shows teeth
- Growls
- Snaps
- Bites
Medical History
Has your dog been spayed or neutered?
- Yes
- No
- I don't know
Has your dog ever had surgery?
- Yes
- No
- I don't know
Surgery Details
Please explain.
Vet Behavior
How does your dog behave during visits to the vet?
Is your dog spayed or neutered?
- Yes
- No
Has your dog been tested for Heartworm?
- Yes (tested negative)
- Yes (tested positive)
- I don't know
Vet Info
Please provide your veterinarian's name and phone number (Pet Haven will require records prior to placement).
Additional Info
Is there anything you want a new family to know about your dog’s interaction with men, women, children, other dogs, cats, other animals or people?
Other Options
Are you interested in discussing options other than surrender with a Pet Haven representative (such as training techniques or behavior assistance)?
- Yes
- No
Name
This field is for validation purposes and should be left unchanged.

Owner Surrender – Dog

Dog Owner Surrender/Return

Medical History