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PSDR - Dog Surrender Application
As we are a foster-based organization, we may not always have a foster suitable or available for your dog.
Name
*
First
Last
Email
*
Phone
*
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-
###
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Basic Information
Dog's Name
*
Breed (or best guess)
*
Approximate weight of dog in pounds
Date of Birth (or best guess)
*
MM
/
DD
/
YYYY
Sex
*
Please select
Male
Female
Third option
Spayed or Neutered
*
Yes
No
Not sure
How long have you owned this dog
*
Date of last Rabies vaccination
MM
/
DD
/
YYYY
leave blank if unknown or if no proof from veterinarian is available
Date of last Parvovirus vaccination
MM
/
DD
/
YYYY
leave blank if unknown or if no proof from veterinarian is available
Date of last Distemper vaccination
MM
/
DD
/
YYYY
leave blank if unknown or if no proof from veterinarian is available
Training / Socialization History
Reaction to children
*
Please select
good with children of all ages (0-14 years old)
good with older children only (10-14 years old)
is not good with children
has never been exposed to children
Reaction to other dogs
*
Please select
Good with all dogs
Good with most dogs
Not good with most dogs
Has not been exposed to other dogs
Describe how your dog generally reacts to strangers
Please explain (as detailed as possible) every situation where your dog has bitten another dog or human, within the last 6 months.
Kennel Training (select best fit)
*
Uses kennel daily
Uses occasionally, but is comfortable inside
Uses occasionally, but is NOT comfortable inside
Has never used a kennel
House Training (select best fit)
*
Has not had an accident in the house in 6 months or more
Has had 1-10 accidents in the house in the last 6 months
Has had 1-10 accidents in the house in the last month
Uses pee pads in the house reliably without accidents
Uses pee pads and has regular accidents in the house
Describe any health issues your dog has had or currently has
What items will you be sending with your dog
*
I will not be sending any items with my dog
Food and/or Treats
Kennel
Bed
Bowls
Collar and/or Leash
Toys
Select all that apply
Reason for surrendering dog
*
Is there anything else you would like to tell us about your dog?
We ask for a $60 fee to help cover the costs your dog will incur while in our care.
*
I am able to pay this
I am not able to pay this
I am not willing to pay this
Please include a recent picture of your dog, if you have one
Thank you for completing this surrender form.
We will contact you within 2 business days to let you know if we do or do not have a suitable foster home for your dog. If you do not hear from us within 2 business days, please email prairieskydr@hotmail.com to ensure your application was received.
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