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Dog/Puppy Surrender Application

Please fill in the blanks and click Submit. If we are able to accept your animal into our program you will be asked to pay a surrender fee of at least $50 per animal/litter. The surrender fee is a non-refundable fee used to help us cover our veterinary, food, shelter and other expenses for the cat. If we are able to accept the dog, the surrender fee can be paid by check at the time of acceptance or online.

Answers for all questions are required except for those marked as Optional. However, it is in your best interests to answer all questions about your cat so we can find a home for him/her!

First and Last Name:
Home Address (optional):
City (optional):
State (optional):
Zip Code (optional):
Home Phone:
Alternate Phone:
E-mail Address:
Dog's Name:
Dog's Age:
Spayed/Neutered:
Yes No
Breed/Mix:
Color:
Microchipped:
Yes No

Microchip #:
Are you the first owner:
Yes No
If no, do you know what happened with the prior adoption?:
Was your dog adopted from HALO Animal Rescue:
Yes No
If no, and the dog was adopted from a rescue, what is the name of the rescue group/shelter:
Did you call the other rescue group/shelter for help finding a home:
Yes No
If yes, what was the response:
If you didn't get it from us, and you didn't get it from another rescue group or shelter, where DID you get it from (neighbor, pet store, breeder, newspaper, etc.)?:
Dog's approximate weight:
Dog's gender:
Male Female
Why are you surrendering the dog/puppy:
How long did you own the dog/puppy:
Did you try to find alternative home:
Veterinarian Name and Phone Number:
Does the dog/puppy have any physical issues/allergies:
Last Rabies Vaccine Date:
4-in-1 Vaccine:
Brand of food dog eats:
Daily amount of food eaten:
Good with strangers:
Yes No
Good with children:
Yes No
Good with dogs:
Yes No
Good with cats:
Yes No
List any bad habits:
Sleeps with you:
Yes No
Allowed Indoors/Outdoors:
Indoors Only No Both
Housebroken:
Yes No
Urinates in the house (including lifting leg on furniture):
Yes No
Chews:
Yes No
Digs:
Yes No
Likes car rides:
Yes No
Allowed on furniture:
Yes No
Guard food or toys:
Yes No
What would be the ideal home for the dog:
Bites:
Yes No
Hides:
Yes No
Most Appealing Traits:
For a stray dog/puppy, you are providing the following additional information, which you promise is true and correct on the date of this Agreement:
When/Where was it found:
Did it live in or around your home or elsewhere:
Any information about who might own the Dog:
Is there any evidence that the Dog/puppy is suffering from any bites, wounds or other injuries:
Scanned for Microchip:
Yes No
How did you hear about HALO?
How much can you donate if we are able to take in this animal:
I understand by submitting this application, my information may be shared with other animal welfare organizations and rescue individuals in an attempt to accommodate my needs if HALO Animal Rescue is unable to do so.


Please click the Submit button only one time! It will take a few seconds for our system to process this form.



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