Dog Surrender Form

Dog Surrender Form: Dog's Name *

Breed *

Age *

Choose applicable *

Male Female Spayed Neutered

Has this dog ever bitten anyone? *

Did it draw blood? *

Please explain the bite incident. *

How does this dog let you know it needs to go out? *

Can the dog be left alone for long periods of time? *

Does the dog enjoy car rides? Get carsick? *

Can the dog be trusted alone in the car? *

Can the dog be trusted alone in fenced yard? *

If no to either, please explain *

Where does the dog sleep? *

Is the dog crate-trained? *

Where is the dog when the family is eating? *

Has this dog ever been to a vet? *

What vet and what name is pet listed under? *

Please explain anything else we need to know about this dog to find the right home. *

If yes, how was he? *

Contact info for vet. *

If this dog is sensitive to being touched, please explain. *

Does this dog have vet records? *

Is this dog possesive of food, toys or people? *

As owner or agent of the owner of this dog described herein, I do hereby assign ownership to 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. *

We Would Love to Have You Visit Soon!
located 4 miles east of hayward on highway 77 east
10812 N O'Brien Hill Road

Hours

M-Sat 11am - 3pm

Telephone

715-634-5394

Email

nhs1@centurytel.net

Mailing address

PO BOX 82
Hayward, WI 54843

Find us on Facebook

The NHS is a nonprofit 501(C)3 organization and receives NO funds from any local, state or federal government. We are a "no-kill" shelter. State of WI Licensed & Inspected, License No. 267329-DS