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

First and Last Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone

Alternative Phone

Ext:

Medical History

Veterinarian Name

Clinic/Practice Name

Clinic/Practice Phone Number

Is this dog up-to-date with a rabies vaccination?

Yes

Date of last rabies vaccination:

Which type of rabies vaccination did this dog receive?

1-year

3-year

Unsure

Please list any medication and dosage this dog currently receives (including supplements):

Has this dog ever had serious medical issues?

Yes

Unsure

If yes, please explain:

Describe this dog's behavior while at the veterinarian (ex. is a muzzle or medication needed):

Diet and Feeding

What brand of dog food is fed to this dog?

How much and at what time(s) is this dog fed?

What is this dog's favorite treat?

Acknowledgement

Check this box in acknowledgement of the $60 surrender fee to help offset care of this dog if accepted into the Adoption Program.

Client Information

Dog Information

Medical History

Home Environment

Who lives in the home?

Pet Background

Diet and Feeding

Environmental Background

Behavior Background

Behavior Screening

Acknowledgement

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