DRNC Surrender Form

DRNC Surrender Form

dachshund surrender form Form Preview
DRNC Surrender Form
  • Surrender Form

    ALL QUESTIONS MUST BE ANSWERED OR FORM WILL BE RETURNED FOR COMPLETION. TYPE IN N/A IF A QUESTION DOES NOT APPLY.
  •  -  - Pick a Date
  • Dog's Information


  • Owner's Information

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  • Veterinary and Medical Information

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  • Spay/Neuter Fee:

    If the dog is NOT spayed or neutered at the time of surrender, a $100 fee may be charged unless the dog is of advanced age or has a medical issue which precludes the procedure. The fee MUST be paid at the time of surrender, unless other arrangements have been made in advance.
  •   Date
    Rabies
    DHLPP
    General checkup
    Heartworm test
  • Behavior Profile

    It is important that you describe any and all of the dog's behavioral qualities and problems. To place your dog in a permanent and loving home, we need to know as much as possible about his/her good and bad traits.
  •   Yes No
    Is the dog trained to use a doggie door?
    Is the dog crate trained?
    Is the dog leash trained?
    Has the dog had any obedience training?
    Likes to ride in the car?
  • Total:   0 100  
  •   Unknown Never Sometimes Always
    Likes/tolerates bath time
    Likes/tolerates nail trim
    Likes/tolerates grooming
    Excessive barking
    Separation anxiety
    Running away
    Toy guarding
    Food/treat guarding
  • Terms and Conditions

  • By checking the following box and/or typing or signing my name, I certify that...

    • I am the owner of this animal and hereby relinquesh all present and future rights and claims to the subject animals, and to all possessions transferred with it to Dachshund Rescue of Northern California (DRNC). 
    • I have fully informed DRNC of all known or suspected medical and/or behavioral problems and concerns with this animal.
    • I have indicatd all information possible to ensure the animal's continued happiness and welfare. 
    • I understand that I may not be provided with information about this animal's whereabouts once surrendered. 
    • I give the aforementioned Veterinarian, Clinic, and any other Veterinarian/Clinic that has treated this animal for any reason, and their staff permission to discuss this animal with DRNC and provide copies of any and all paperwork with regard to this animal. 
  • BEFORE YOU SUBMIT - did you answere all the questions? 

    Please check because incomplete forms will be kicked back for completion and delay the process. If a question does not apply to your dog, just type n/a.

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