Owner Surrender - Dog - Pet Haven of Minnesota

Date*

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

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
Female

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?*

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.

Traits & Habits

Are there any wonderful, special traits or habits that you would like his/her new family to know about?

Does your dog have accidents in the house?*

Yes
No

How often do the accidents happen?

How long can your dog "hold it"?*

Time Alone*

How long is your dog left alone without people most days?

Is your dog crate trained?*

Yes
No

Time in Crate*

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

Location Alone*

When left alone where is your dog located?

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
None

Handling*

How does your dog react to handling such as petting, hugging or bathing?

Does your dog get along with other dogs?*

Please describe your dog's play style/energy level.

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).

Car Behavior

How does your dog behave in the car? Please check all that apply.

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 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 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

Training

Has your dog completed any training? If so, please describe.

Commands

What commands does your dog understand?

Sit
Stay
Leave it
Come
Down

What are the dog’s favorite kinds of toys?

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

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?

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?

Photos

Please attach 1-2 photos of your pet (upload file size limit: 50 MB)

Drop files here or

Vet Records

Please attach your dog's vet records.

Drop files here or

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

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

Comments

This field is for validation purposes and should be left unchanged.

Owner Surrender – Dog

Dog Owner Surrender/Return

Medical History