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CANINE SURRENDER APPLICATION
(IF YOU ARE LOOKING TO SURRENDER MORE THA
N ONE DOG, YOU MUST COMPLETE AN APPLICATION FOR EACH DOG.)
First Name
Last Name
Phone
Today's Date
Email
Enter your Address
Date of Birth
Zip Code
Dog's Name
Dog's Breed
How long have you had the dog for? Be Specific
How old is the dog? If you know birthday, also provide here.
Spay or Neutered?
*
Yes
No
Sex
*
Male
Female
What is your relationship to the dog?
*
Owner
Friend/Caretaker
Foster Owner
Family of Owner
Other
Where did you get the dog from?
*
This Organization
Friend/Relative
Found/Stray
Breeder/Pet Store
Other Shelter/Rescue
Why are you looking to surrender the dog?
Please list members of your household including ages.
What type of exercise do you provide the dog?
Fenced Yard
Dog Park
Walking Trails / Running
Hiking
Other
What other animals does the dog live with?
No Other Animals
Dogs
Cats
Small and Furry
Other
If the dog lived with or has been around children, how does the dog react with them? (Please explain, was he/she playful? Did they usually keep a distance? was the dog very jumpy?)
How does the dog react when an unfamilar person enters or approaches the yard or house?
Are visitors able to pet the dog? Does the dog keep a distance from visitors?
Does the dog chase or attempt to chase any of the following?
Joggers
Bicycles
Skateboarders
Cars/Motorcycles
Outdoor Cats
Squirrels or other animals
Doesn't Chase
How does the dog react when an unfamilar person approaches on leash?
How does the dog react when they see another dog on leash?
Has the dog ever played off leash with another dog?
How does the dog usually react when you or another family member gives the dog a bath?
Never Tried
Allows
Afraid
Shows Teeth/Growls
Snaps
Bites
None of these
How does the dog usually react when you or another family member brush the dog?
Never Tried
Allows
Afraid
Shows Teeth/Growls
Snaps
Bites
None of these
How does the dog usually react when you or another family member touch dog's paws?
Never Tried
Allows
Afraid
Shows Teeth/Growls
Snaps
Bites
None of these
Do you take the dog outside to go to the bathroom?
Yes (1 Time Daily)
Yes (2 Times Daily)
Yes (3 Times Daily)
Yes (4 Times Daily or More)
No / Paper Trained
Does the dog usually have "accidents" in the house?
Yes (1 Time Daily)
Yes (2 Times Daily)
Yes (3 Times Daily)
Yes (4 Times Daily
No / Never
Where does the dog spend most of his/her time?
Inside the House, Runs Free
Inside the House, In Cage
Outside the House, Tied / Caged
Other
How long is the dog left alone during the day?
Never
1-3 Hours
4-8 Hours
9-12 Hours
Over 12 Hours
When the dog is left alone, is he/she
Outside
Free in Home
Confined to a Room
In a cage
Other
When left alone, does the dog usually show any of the following behaviors?
Destroys Household Items
Urinate/Defecate
Bark
Cry
Other
When you are home, does the dog usually show any of the following behaviors?
Destroys Household Items
Urinate/Defacate
Bark
Cry
None of These
When the dog plays, does he/she typically
Jumps
Growls
Barks
Bites Lightly
Bites Hard
None of These
What toys does the dog like?
Balls
Frisbee
Plush
Squeaky
Tug Toy
Chew Toys
Other
None
Is the dog scared of anything?
Please tell us the dog's "bad habits"
Where does the dog usally sleep overnight?
Cage
Floor
Dog Bed
Couch
Owner's Bed
Outside
Other
Has the dog seen a trainer? If so, provide trainer's name and phone number
Does the dog have any problems riding in a car?
Has the dog escaped your property 2 or more times in the last 6 months?
Is there any report of the dog ever inflicting a serious bite to a person (such as an attack or a bite requiring hospitalization)?
*
Yes
No
Don't Know
Is there any report of the dog ever inflicting a serious bite to a dog?
*
Yes
No
Don't Know
Has the dog ever attacked another dog resulting in severe injury or death to another dog?
*
Yes
No
Don't Know
Has the dog shown any of these behaviors around a food bowl?
Shows Teeth
Growls
Snaps
Bites
None of these
Has the dog shown any of these behaviors while eating bones, rawhides, or treats?
Shows Teeth
Growls
Snaps
Bites
None of these
Has the dog shown any of these behaviors while playing with a toy?
Shows Teeth
Growls
Snaps
Bites
None of these
Has the dog shown any of these behaviors while in possession of a stolen object?
Shows Teeth
Growls
Snaps
Bites
None of these
Has the dog shown any of these behaviors when the dog was disturbed while sleeping?
Shows Teeth
Growls
Snaps
Bites
None of these
Has the dog shown any of these behaviors when an adult or child entered the house or yard?
Shows Teeth
Growls
Snaps
Bites
None of these
Has the dog shown any of these behaviors when an adult or child approached or reached towards the dog?
Shows Teeth
Growls
Snaps
Bites
None of these
Does the dog see a veterinarian at least once a year?
*
Yes
No
Don't Know
What is the name and contact information for the veterinarian that has seen the dog?
Does the dog need to be muzzled at the veterinarian?
*
Yes
No
Don't Know
Does the dog have any current or past medical conditions?
Is the dog currently on any medication or special diet?
What type of food does the dog eat?
Dry
Wet/Canned
Table Scraps
Special Diet
What flavor of food does the dog eat?
Please share any additional helpful information about the dog
Upload a full picture of the dog.
Upload supported file (Max 15MB)
As part of our review process, we may require to observe the dog to confirm medical or behavioral condition prior to final approval. If this visit is necessary, do you agree to allow our staff to conduct this visit?
*
I agree
I disagree
By submitting this Dog Surrender Application, you understand that it does not guarantee that the dog will be accepted for surrender. We understand that there are different circumstances that may lead to the need for surrender, other resources may be available or more appropriate for the dog. The final decision to approve a surrender is at the sole discretion of the GSARC.
*
I understand
As of January 1, 2024, The Garden State Animal Rescue Center has implemented a surrender application donation of $20 to help with the increasing cost of care for our furry friends. The donation is non-refundable and must be received prior to review of surrender application.
*
I understand
By submitting this Dog Surrender Application, you understand that if the approved, there will be a surrender donation required at the time of surrender. (GSARC Staff will go over this during review call)
*
I understand
By submitting this application, you confirm that all information provided herein is truthful and accurate. (If any infomation is determined to be false during the course of our review, your application may be rejected at the sole discretion of the GSARC.)
*
I understand
Submit Application
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