Dog Relinquishment

First Name (required)

Last Name (required)

Street Address (House Number, Street) (required)

City (required)

State (required)

ZIP Code (required)

County (required)

Is this where the dog is located? If not, where is the dog located?

Phone Number (required)

Your Email (required)

When is the best time to call?

MorningAfternoonEvening

Are you the dog’s owner? If not, who is and what is your relationship?

Dog’s name

Dog's Age

Breed

Weight

Dog's Gender

MaleFemale

Spayed/Neutered

YesNoNot Sure

If not spayed or neutered please tell us why and would you be willing to have the dog altered prior to relinquishment or provide a donation to offset the cost of the procedure?

Why is the dog being relinquished? Please be specific.

Is the dog up to date with all vaccinations and veterinary care?

YesNoNot Sure

Date of last veterinary visit

Date of last heartworm/lyme test and the result

Does the dog have any medical conditions?

Is the dog on any medications? Please list med and dosage

Have you worked with a trainer or behaviorist to correct any behavioral challenges? For how long?

Has the dog bitten anyone? If so, when and what were the circumstances? Was medical treatment necessary? Please be specific.

How long can you keep the dog?

Is the dog good with other dogs?

How long is the dog typically left alone?

Where is the dog accustomed to being kept? (indoors, outdoors)

Is the dog crate trained, housetrained?

How long have you owned the dog?

Are you aware of the dog's history prior to your ownership? (shelter, stray, etc)

Please list the pets that are currently in your home (breed, weight, age). How has this dog interacted with them?

This form is for informational purposes only and does not guarantee we will be able to take your dog. ASR does not have kennels and is dependent upon available foster homes. We are unable to take dogs without prior notice allowing for time for an evaluation process. This is done to ensure your dog is placed in an appropriate foster home. We do not have paid staff and the process is supported solely by volunteers. If you require immediate placement, please contact your local shelter. Thank you!

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