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Dog Surrender Questionnaire

Fill Out Dog Surrender Questionnaire

PLEASE READ BEFORE SUBMITTING THIS FORM:

Lake Humane Society is a managed intake facility, which means we do not euthanize healthy animals for time or space. All of our animals that come in, stay until they are adopted out to loving homes! Because of this, we almost always work off of a waitlist for new intakes and schedule surrender appointments based off of the amount of adoptions we go through in a day, on top of helping any animals our humane agent may bring in.
While we try to help any animal that needs to be surrendered, there are circumstances that the animal may not be a good fit at our facility. If we cannot accept it, we will try to provide any other resources we may have to help assist you.
PLEASE NOTE: Intakes are by appointment only. 

Dog Surrender Questionnaire

"*" indicates required fields

PLEASE NOTE:
Name*
(please make sure this is accurate as this is how the intake coordinator will reach out to you once this form is submitted).
Address*
Male/Female?*
Spayed/Neutered?*
Max. file size: 2 GB.
Have you attempted to contact and return your dog to the person/place/facility where you got them from?*

Does your dog use a crate?*
How often does your dog have accidents in the home?*

How do they spend their time outside?*

Did your dog ever try to escape the yard?*
Has your dog ever ran away?*
Who all lives in the home? Check all that apply.*
Do they ever need a break from children?*
Does your dog ever growl or show their teeth?*
This dog is protective of: Check all that apply.*
Has your dog ever bitten someone? (A bite is defined as breaking skin with teeth that causes bleeding)*
Has your dog ever attempted to bite someone?*
List the age, breed, and sex of any other dogs living in the home:*
Has this dog ever attacked and hurt another animal (including wildlife)?*
Can you remove an object from their mouth?*

Can you touch or take their food away while they are eating?*

Please list any commands your dog knows (including protective commands).*
Please list any type of training your dog has gone through, including date and name of trainer/facility.*
Is your dog up to date on vaccines?*
Does your dog need to be muzzled at the vet?*
Please list any significant health issues.*
Please list any current medications, including heartworm and flea preventative and when these medications were last given.*
Max. file size: 2 GB.
We understand giving up your pet is extremally hard. Before surrendering, would you like to discuss resources or avenues to help keep you and your dog together?*
I agree to check my email (including my junk/spam folder) regarding important communication from Lake Humane Society in regards to this surrender form.*
I understand that I MUST have an intake appointment and that the shelter does not accept walk-in surrenders.*
I understand that Lake Humane Society requires an intake fee of $50 per dog and $100 per puppy to help offset the cost of caring for this dog(s) during it's time with us. Under certain circumstances, we can reduce or waive this fee, but it must be discussed with the Intake Coordinator prior to your intake appointment.*
I understand that Lake Humane Society is NOT an open admission shelter and that Lake Humane Society is a limited admission, unlimited stay humane society. I understand my application can be denied for any reason.*
By checking the box below, I understand that Lake Humane Society has the right to deny my surrender form for any reason. I also understand that if my surrender form is accepted, there may be a lengthy wait because Lake Humane Society does NOT euthanize animals for time or space reasons and can only schedule dogs as cage space allows.*
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EIN: 34-1246277

Lake Humane Society is a 501(c)(3) nonprofit organization. All donations are tax-deductible in full or in part.

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    Wednesday: Closed
    Thursday: 12 PM - 7 PM
    Friday & Saturday: 12 PM - 5 PM
    Holidays: Closed
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Closing Early 12/11

Our shelter will be closing at 4:30 pm today. Please visit our animals before then!