Surrender - Bright Eyes Dog Rescue

Please be aware that we are reliant on a suitable foster home being available and are quite often at capacity so there will likely be a wait before we can place your dog. Our current wait times are approximately 6 months right now. We encourage you to contact other rescues as well, however we would appreciate if you would let us know if you end up placing your dog with another rescue. We will contact you as soon as a foster home is available.

Are you the owner of this dog or did you find this dog? *

I own this dog
I found this dog

Did you adopt this dog from Bright Eyes Dog Rescue? *

Yes
No

What date did you find this dog? *

Owner Name *

First

Last

Guardian Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Pet Details

Dog's Name *

Breed or cross *

Age *

Sex *

Female
Male

Where did you get this dog from? *

How long have you owned the dog? *

What is your reason for surrendering? *

What have you done to find the owners? *

Has the dog ever shown any aggression towards people or other animals? *

Has the dog ever bitten anyone? If so what were the circumstances? *

Any fears or things the dog doesn't like? *

Good with Dogs? *

Yes
No
Not Sure

Good with Cats? *

Yes
No
Not Sure

Good with Kids? *

Yes
No
Not Sure

Potty Training: *

House Trained
Pee Pad Trained
None

Kennel Trained: *

Yes
No

Up to Date on Shots *

Yes
No
Not Sure

Spayed/Neutered *

Yes
No
Not Sure

Microchipped *

Yes
No
Not Sure

Microchip Number

Do you know who the vet is for this dog? *

Yes
No

Name of veterinary clinic *

Name of vet *

Veterinary clinic phone *

Veterinary clinic address *

Is there any other additional information that we should know about? *

I declare that I am the current owner of the dog(s) described above. By signing this form, I hereby relinquish all claims and ownership of the dog(s) described above to Bright Eyes Dog Rescue and its officers. I acknowledge that I will not be able to reclaim this dog(s) once it is in the possession of Bright Eyes Dog Rescue though I may apply for adoption of the dog(s) understanding that the decision for placement is solely at the discretion of Bright Eyes Dog Rescue and is subject to adoption fees. I declare that the above information is correct to the best of my knowledge and that I have not concealed or withheld any information regarding the above described dog(s) and its history. I understand that falsification or omission of information regarding the above described dog(s) may result in my being held liable for future actions of the dog(s); for future medical expenses of the dog(s); and for legal expenses involved in any dispute of my right to surrender this dog to Bright Eyes Dog Rescue. I understand that the information provided may be released to any potential foster or adoptive home.

I declare that I am the current guardian of the dog(s) described above. By signing this form, I hereby relinquish all claims and ownership of the dog(s) described above to Bright Eyes Dog Rescue and its officers. I acknowledge that I will not be able to reclaim this dog(s) once it is in the possession of Bright Eyes Dog Rescue though I may apply for adoption of the dog(s) understanding that the decision for placement is solely at the discretion of Bright Eyes Dog Rescue and is subject to adoption fees. I declare that the above information is correct to the best of my knowledge and that I have not concealed or withheld any information regarding the above described dog(s) and its history. I understand that falsification or omission of information regarding the above described dog(s) may result in my being held liable for future actions of the dog(s); for future medical expenses of the dog(s); and for legal expenses involved in any dispute of my right to surrender this dog to Bright Eyes Dog Rescue. I understand that the information provided may be released to any potential foster or adoptive home.

By signing this form, I hereby authorize the veterinary clinic described above to transfer the above described dog(s) veterinary records to Bright Eyes Dog Rescue and its officers. I understand that the information provided may be released to any potential foster or adoptive home.

Signature *

Clear Signature

I declare that I am the current guardian of the dog(s) described above. By signing this form, I hereby relinquish all claims and ownership of the dog(s) described above to Bright Eyes Dog Rescue and its officers. I acknowledge

Please include 1 or 2 good quaility photos of the dog.

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Please provide a copy of the most recent vaccination record.

Drag & Drop Files, Choose Files to Upload

Please provide any additional medical records.

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Please provide any training cerificates.

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Date *

Bright Eyes Dog Rescue Surrender Form

Pet Details

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