Pet Surrender Application – Inhouse

Pet Surrender Form

Step 1 of 9

Name
First Last
Address
Street Address City State ZIP Code
Home Phone
Mobile Phone
Email
Age

What is the hound's name?*
What is the hound's gender?
Is the hound spayed or neutered?
Please provide a color description of the hound:
How old is the hound?
What brand of dog food is the hound currently being fed?

Why do you want to surrender the hound?
From where did you get the hound?
How long have you had the hound?
Years Months
Is the hound crate-trained?
Which statement best describes the hound's level of house-training?

Please describe the type and duration of exercise the hound usually receives
How many hours daily is the hound outdoors?
How many hours daily is the hound indoors?
How many hours daily is the hound left alone?
When left alone, where is the hound left?
Is the hound an escape artist?
How does the hound escape?

Can BHRSC contact the hound's veterinarian regarding this application?
Please list your veterinarian's name and phone number:
When was the hound's last visit to the veterinarian?
MM slash DD slash YYYY
At the hound's last veterinarian visit, did the vet make any recommendations for further treatment or suggest follow up care?
Please elaborate on the suggested recommendations/follow up care from the hound's last veterinarian visit:
Is the hound up-to-date on vaccinations?
Has the hound ever had a dental cleaning?
When was the last dental cleaning the hound had?
MM slash DD slash YYYY
Is the hound micro-chipped?

Is the hound on a heartworm preventative?
When was the hound last tested for heartworm?
MM slash DD slash YYYY
What were the results of your hound's last heartworm test?
Does the hound suffer from any injuries or illnesses?
Please provide details on any injuries or illnesses the hound has:
Is the hound currently on any medications
Please list the hound's current medications:
Does the hound travel to Northern CA?
Does the hound travel outside of California?

Are you willing to keep (Foster) the hound until a Forever Home is found?
Until what date are you willing to Foster?
MM slash DD slash YYYY
Please provide any additional information you think we should know:
Would you be willing to make a tax-deductible donation, at the time of the hound's surrender, on behalf of the hound, which will go to offset his/her expenses and the expenses of other hounds in the care of BHRSC?
How did you hear about Basset Hound Rescue of Southern California?
Please attach a picture of hound:
Drop files here or

Max. file size: 128 MB.
Please attach hound's vaccination records:
Drop files here or

Max. file size: 128 MB.
BHRSC Pet Surrender Agreement
Basset Hound Rescue of Southern California (BHRSC) requires all owners surrendering their dogs to Read, Acknowledge their Understanding of, and Agree to the terms of the BHRSC Pet Surrender Agreement. If you choose not to Read, Acknowledge your Understanding of, and Agree to the terms, BHRSC will NOT consider your dog for intake.

Please click on the following link to access a copy of BHRSC's Pet Surrender Agreement:
BHRSC-Pet-Surrender-Agreement
- I have Read, Understand, and Agree to the terms of BHRSC's Pet Surrender Agreement.
***Once BHRSC takes possession of your dog, you will relinquish all rights to the dog and will not be able to reclaim the dog for any reason. Do you understand and accept that upon surrendering your dog to BHRSC, you relinquish all rights to the dog and will not be able reclaim the dog for any reason?

As your acknowledgement of your Understanding & Agreement to the terms of your dog's surrender to BHRSC, please type your Full Name In the text field above.

Notes
Please click on the Submit button below to complete your BHRSC Pet Surrender Application.
Name
This field is for validation purposes and should be left unchanged.

Pet Surrender Application – Inhouse

Pet Surrender Form

Step 1 of 9

As your acknowledgement of your Understanding & Agreement to the terms of your dog's surrender to BHRSC, please type your Full Name In the text field above.

Please click on the Submit button below to complete your BHRSC Pet Surrender Application.