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Northwoods Humane Society
Adoptable Animal Shelter in Hayward, WI
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Dog Surrender Form
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Donate!
Adoptable Animals
Adoption Process
Dog Adoption Form
Cat Adoption Form
Small Animal Adoption Form
Get Involved!
Donations
One-Time Donations
Monthly Donations
Donate Thrift Items
Become a Member
Volunteer
Foster Home Care Volunteer Application
Adult Volunteer Application
Junior Volunteer Application
Volunteer Photo Gallery
Other Ways to Give
Visit our Thrift Shop
Events
Thrift Shop
Community Outreach
Articles & Newsletters
Bark Parks
Behavioral Issues
Lost & Found
Pet Medical Help
Spay/Neuter
Surrender
Dog Surrender Form
Cat Surrender Form
Stray Surrender Form
About Us
Contact
Home
Dog Surrender Form
All fields are required.
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
(Required)
Daytime Phone
(Required)
Dog's Name
(Required)
Dog's Name
Breed
(Required)
Breed
Age
(Required)
Age
Male or Female
(Required)
Male or Female
Male
Female
Spayed or Neutered
(Required)
Spayed or Neutered
Spayed
Unspayed
Neutered
Unneutered
Has this dog ever bitten anyone?
(Required)
Has this dog ever bitten anyone?
Yes
No
Did it draw blood?
(Required)
Did it draw blood?
Yes
No
Please explain the bite indicent
(Required)
Please explain the bite indicent
How long have you had this dog?
(Required)
How long have you had this dog?
Age when you got this dog
(Required)
Age when you got this dog
How did you get this dog?
(Required)
How did you get this dog?
Please select
Stray
Gift
Friend
Pet Shop
Shelter/Rescue
Breeder
Abandoned
Why do you want to surrender this dog?
(Required)
Why do you want to surrender this dog?
What have you done to re-home this dog?
(Required)
What have you done to re-home this dog? Why did it not work?
Is this dog potty trained?
(Required)
Is this dog potty trained?
Yes
No
How does this dog let you know it needs to go out?
(Required)
How does this dog let you know it needs to go out?
Where is this dog used to being kept?
(Required)
Where is this dog used to being kept?
Crate
Free roaming
House
Yard
Chained
Have you seen any of these behaviors?
(Required)
Have you seen any of these behaviors?
Aggression
Startling
Fear of Storms
Growling
Fear of Noise
Begging
Biting
Climbing
Overprotective
Fighting
Animal aggression
Not applicable
Choose any that fit this dog.
(Required)
Choose any that fit this dog.
Jump fences
Tear carpet
Tear furniture
Dump trash
Bark/howl
Chase cars/bikes
Walk well on leash
Ride well in cars
Dig
Chew
Not applicable
Please explain any of the noted behaviors.
(Required)
Please explain any of the noted behaviors.
Can the dog be left alone for long periods of time?
(Required)
Can the dog be left alone for long periods of time?
Yes
No
Choose any that apply. Does this dog NOT get along with:
(Required)
Choose any that apply. Does this dog NOT get along with:
Children
Women
Men
Cats
Dogs
Other animals
Don't know
Not applicable
Choose any that apply. This dog has NOT had trouble with:
(Required)
Choose any that apply. This dog has NOT had trouble with:
Children
Women
Men
Cats
Dogs
Other animals
Can the dog be trusted alone in the car?
(Required)
Can the dog be trusted alone in the car?
Yes
No
Can the dog be trusted alone in fenced yard?
(Required)
Can the dog be trusted alone in fenced yard?
Yes
No
If no to either, please explain
(Required)
If no to either, please explain
Does the dog enjoy car rides?
(Required)
Does the dog enjoy car rides?
Yes
No
Does the dog get carsick?
(Required)
Does the dog get carsick?
Yes
No
Is the dog crate-trained?
(Required)
Is the dog crate-trained?
Yes
No
Where does the dog sleep?
(Required)
Where does the dog sleep?
Where is the dog when the family is eating?
(Required)
Where is the dog when the family is eating?
Where and how often a day is the dog fed?
(Required)
Where and how often a day is the dog fed?
Brand/type and amounts?
(Required)
Brand/type and amounts?
Has this dog ever been to a vet?
(Required)
Has this dog ever been to a vet?
Yes
No
Are vet records available for this dog?
(Required)
Are vet records available for this dog?
Yes
No
Vet notes
(Required)
Please summarize any vet visits, if applicable
What vet and what name is pet listed under?
(Required)
What vet and what name is pet listed under?
Contact info for vet, including phone number
(Required)
Contact info for vet, including phone number
Is this dog possessive of food, toys or people?
(Required)
Is this dog possessive of food, toys or people?
Yes
No
If this dog is sensitive to being touched, please explain.
(Required)
If this dog is sensitive to being touched, please explain.
Please explain anything else we need to know about this dog to find the right home.
(Required)
Please explain anything else we need to know about this dog to find the right home.
As owner or agent of the owner of this dog described herein, I do hereby assign ownership of said dog to the Northwoods Humane Society. NHS will become the sole owner of the animal and may care for the animal in any manner the society sees fit. To the best of my knowledge, as owner or agent of the owner this animals HAS NOT BITTEN ANY PERSON, in the last 10 days. Please type your name in the box as electronic authorization.
SIGNATURE
(Required)
SIGNATURE
Date
(Required)
DATE
MM slash DD slash YYYY
Challenge
(Required)
Please type RESCUE to prove you are human:
CAPTCHA
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