Dog Surrender Application

If you think that surrendering your dog to MHHS is the best option for your family, please fill out the form below and a staff member will review your case. Please note that we cannot accept pets that have significant medical issues or behavioral issues into our adoptions program. 

To help offset the substantial cost of caring for and placing your pet, there is a surrender fee of $60 for one dog, or $100 total for two or more dogs. We do offer income-based assistance with this fee, on a case-by-case basis.  

Client Information

Alternative Phone

Dog Information

Has this dog ever been under the care of MHHS?
Is this dog spayed/neutered?
Has your dog ever been bred?
Are there plans to breed this dog?
If reason(s) for surrender could be addressed with help through MHHS, would keeping this dog be an option?

Medical History

Is this dog up-to-date with a rabies vaccination?
Which type of rabies vaccination did this dog receive?
Has this dog ever had serious medical issues?

Home Environment

This information will help us determine what type of home will be best for this animal in the future.

Who lives in the home?

List all people and animals living in the household:
How many people live in the home?
How many animals live in the home (including the dog in question)?
In what type of area is your home located?
Have you changed residence since acquiring this dog?
Has the household make-up changed since acquiring this dog (addition or loss of animals or humans)?

Pet Background

How was this dog acquired?
Is this your first dog?
Has this dog had previous owners?

Diet and Feeding

Environmental Background

Is this dog ever free in a fenced yard?
Is this dog ever tied outside?
When tied outside, is this dog ever left alone?
Does this dog ever run off leash (not in a fenced yard)?
Is this dog housetrained?
Does this dog ever have accidents in the home?
Does this dog (check all that apply):
Where is this dog when home alone?
Where is this dog when there are guests in the home?

Behavior Background

Which type of basic obedience training has this dog received?
Has this dog received any training with the following? (please check all that apply)
Does this dog know any commands or tricks?
Does this dog jump on you or others without permission?
Does this dog paw at you or others?
Does this dog lick you?
Does this dog mount people?
Does this dog mount objects or other animals?
Does this dog ever bark at you?
Does this dog bark at other times?
In general, what is this dog's activity level?

Behavior Screening

Please indicate this dog’s reaction to each of the listed scenarios below by using one of the dropdown menu options.
Has this dog ever bitten a person and broken skin?
Has this dog ever growled or snapped at anyone?
Check the behaviors that apply to this dog after an episode: