We are a 501 (c) 3  non profit charity. All donations are tax deductible. 

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SAD EYES ANIMAL WELFARE SOCIETY
Canine Surrender Form
We ask that you complete this form to help us in our evaluation of your situation and so we may find the best, permanent home for your dog. Please be honest with your answers, as this help us learn your dog's personality
and
we can match his or her needs to.
We will contact you to discuss the surrender process and alternative options that may help you to keep your friend in your home. We will have you sign the surrender contract if and when you are certain in your decision.

Name
Address  
Phone  
E-Mail Address
Dog's Name  
Breed Age M/F
Dog's Size? (S/M/L/XL) Dog's Weight?
Spayed/Neutered? Y N
Date
Female: Has she had any litters? Y N
How Many?
How long have you been his/her guardian?
Why are you giving up this dog?
Does the dog get along with:
DOGS Y N CATS Y N CHILDREN Y N
MEN Y N WOMEN Y N  
Aggressive with:
FOOD Y N TOYS Y N TREATS Y N
Do you consider your dog to be an:
ALPHA DOG Y N CALM Y N LAP DOG Y N LAID BACK Y N
OVER PROTECTIVE OF FAMILY Y N
What brand of food does your dog like?
Does your dog enjoy:
WALKS Y N CAR RIDES Y N BATHS Y N GROOMING Y N
Has your dog ever bitten anyone? Y N
What were the circumstances?
Is your dog up to date on all shots?
Records available? Y N
Medical issues?
Notes/Comments
Vet Name
Address
Phone
 
I certify that the foregoing statements made by me are true. If any statements are found to be willfully false, I agree to reimburse Sad Eyes Animal Welfare Society any costs incurred for the care of this dog.