Owner Surrender Form

For dogs needing rehoming consideration

Thank you for trusting us. We understand this decision is not easy, and we appreciate your honesty so we can best help the animal and protect those in our care.

🐾 Owner Information

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Government Issued Identification

Are you the legal owner of this dog?

Yes

No

If no, explain your relationship to the dog:

🐶 Dog Information

Dog's Name:

Breed or best guess:

Approximate Age:

Sex:

Male

Female

Spayed/Neutered?

Yes

No

Unknown

Current Weight:

How long have you had this dog?

Is the dog microchipped?

Yes

No

Chip # (if known):

🩺 Health & Veterinary Care

Is the dog current on vaccinations?

Yes

No

Unknown

On monthly heartworm prevention?

Yes

No

Unknown

Has the dog tested positive for heartworms?

Yes

No

Unknown

Date of last vet visit (if known):

Vet/Clinic Name (if applicable):

Any known medical issues, diagnoses, or recent surgeries? (Include medications or special care needs):

🧠 Temperament & Behavior

Please be honest—this is to ensure everyone's safety.

Has your dog ever bitten a person?

Yes

No

Has your dog ever bitten another animal?

Yes

No

Has your dog ever displayed resource guarding? (food, toys, space)?

Yes

No

Has your dog ever reacted to grooming/nail trimming?

Yes

No

Has your dog ever been involved in a fight with another dog?

Yes

No

Has your dog ever been evaluated by a trainer or behaviorist?

Yes

No

If yes, Please explain:

Describe any incidents or behavioral concerns:

🏡 Daily Life

Is the dog crate trained?

Yes

No

Is the dog house trained?

Yes

No

Can the dog be left alone without issue?

Yes

No

Where does your dog sleep?

How much exercise does your dog typically get daily?

Favorite activities or toys:

Any fears or triggers (vacuums, storms, hats, etc.):

Feeding schedule and food type:

📸 Photos & Records

Please attach at least 2 recent photos (including full body and face)

Please attach medical/vet records (if available)

Please attach behavior or training notes (optional)

📝 Final Details

What would your ideal new home look like for this dog?

Anything else you’d like us to know about your dog’s story or personality?

✅ Agreement

I confirm that I have provided accurate and honest information to the best of my ability.

I understand that completing this form does not guarantee intake by Legacy Paws Rescue.

I understand that if Legacy Paws Rescue is able to help, a surrender agreement will be provided and signed prior to transfer of ownership.

I understand there is a surrender fee.

-Dogs under 7 years old (healthy): $100

-Senior dogs (7+ years), medical needs, or special cases: $75

-Litter of puppies or multiple dogs: $150 (Or $25–$50 per puppy/dog, depending on age and condition)

Surrender fees help cover basic intake costs like vet care, food, and supplies. If you're experiencing financial hardship, please let us know—we’ll do our best to help.

Date

Month

Day

Year

Signature

Signature field is empty.

Donation

$10

$20

$30