EmailMe Form - SGF OWNER SURRENDER FORM

Your Name *

First Last

Email *

Mobile Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Please tell us about the dog you'd like to surrender. Please include the dog's name, breed, sex, age, and weight. *

Why are you seeking to surrender your dog? *

Please summarize the health condition of your dog. Any medical concerns? *

Spayed/neutered? *

Yes

No

Unknown

Up-to-date on vaccines? *

Yes

No

Unknown

Microchipped? *

Yes

No

Unknown

Microchip number & brand, if applicable.

Housebroken? *

Yes

No

Unknown

Crate trained? *

Yes

No

Unknown

Barker? *

Yes

No

Unknown

Good with kids? *

Yes

No

Unknown

Good with cats? *

Yes

No

Unknown

Good with other dogs? *

Yes

No

Unknown

Jumps the fence? *

Yes

No

Unknown

Leash trained? *

Yes

No

Unknown

Food aggressive? *

Yes

No

Unknown

Resource guarding? *

Yes

No

Unknown

Ride well in the car? *

Yes

No

Unknown

Has your dog been to the vet in the past 12 months? *

Yes

No

Unknown

Please list any veterinarians and clinics your dog has been to in the past: *

Has your dog ever ATTEMPTED to attack another ANIMAL? If so, explain. *

Has your dog ever ATTEMPTED to attack a HUMAN? If so, explain. *

What food is your dog fed? And at what times? *

Where does the dog sleep at night? Crate, bed, sofa? *

By checking this box you acknowledge that Sophia's Grace Foundation does NOT pay for dogs. This a free service to help place dogs in new homes when their present owners can no longer keep them. *

Yes, I accept

No, I do not accept

By checking this box you agree that representatives of SGF or a future adopter may contact you in the future to obtain additional information about the dog as needed. *

Yes, I accept

No, I do not accept

By checking this box you certify that you are the owner of this dog and that you are free and clear of all other interests. *

Yes, I accept

No, I do not accept

By checking this box you certify that the dog is not possessed of any dangerous or vicious propensities and that you have not willfully concealed information about the dog. *

Yes, I accept

No, I do not accept

By checking this box you agree to surrender all claims and ownership of this dog. You agree that the dog is now under the complete authority and domain of Sophia’s Grace Foundation and permanently release all claims on the dog. *

Yes, I accept

No, I do not accept

By checking this box you agree to forever release, discharge, and agree to hold harmless and indemnify Sophia's Grace Foundation, it's board members, its volunteers, and agents from all claims, demands, causes of actions, or liability of any kind whatsoever, arising as a result of or in connection with the adoption or other disposition of the above named dog. *

Yes, I accept

No, I do not accept

Please provide your signature below to affirm and certify all above statements. *

Clear

Please acknowledge that Sophia's Grace Foundation is under no obligation to accept your surrender request unless otherwise stated by a representative. *

Yes, I accept

No, I do not accept