Owner Surrender Form | Paws to Peaks Rescue

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Paws to Peaks Rescue

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Fostering, Re-training and Re-homing bird dogs across the Rocky Mountains

Owner Surrender Form

Today's Date*

First name*

Last name*

Email*

Phone Number*

Address*

Dog's Name*

Breed*

Approx Age/DOB*

Color/Description*

Spayed/Neutered?*

Spayed

Neutered

Not fixed

Is dog up to date on shots? If yes when was last vet visit*

Is the dog on any medications?*

Yes

No

If yes, please list out the current medications:

Is your dog microchipped?*

Picture of dog*

Video of dog

Why are you surrendering?*

Please list all training that dog has (select all the apply):*

Kennel Training

House Training

Basic Obedience

Advanced Obedience

Hunt Training

Other

Please provide a Bio on your dog including what he/she likes, dislikes, training, and what you would like a potential adopter or their new forever home to know*

History of any aggression towards humans or other animals?*

Would your dog do best as an only dog or with another dog*

Only Dog

Would like another canine companion

Would do fine either way

Other

Has your dog been around cats? If so how do they do?

Has your dog been around kids? (please select all that apply)

Yes

No

Under the age of 2

Ages 5 and under

Ages 5-10

Teenagers

Adults only

Are you willing to help with transportation to foster or adoptive home? If so, how many hours can you feasibly travel?

What is your timeline for rehoming (ie are you willing to hold onto dog until a great fit comes along or are you dropping at local shelter at next available time?)*

Do you understand that by filling out this form, does not guarantee the rescue will take in your dog or has an immediate placement option for your dog?*

Yes

No

By signing below, you acknowledge IF arrangements are made and the dog is moved out of your care with the assistance of Paws to Peaks Rescue to their new foster or forever home, you are signing over ownership of this dog to Paws to Peaks Rescue.

You agree to the above statement

Signature*

Sign in the box or use the keyboard to type.

Signature field is empty.

Contact

Founder/President:

Gina Deem

Po Box 261

Clancy, MT 59634

Tel: 406-600-2959

pawstopeaksrescue@gmail.com

Thanks for submitting!

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Help us make a difference (please note this method does charge/deducts a 2.9% fee from your total donation. If you would like to help offset this fee please consider covering this fee within your donation as we will be unable to continue to maintain this convenience as a donation option without this fee being covered.

Frequency

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Amount

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Other donation or payment options include: Cash, Check, Venmo (no fees).

PLEASE NOTE:

The Pay Now button is if you would like to pay for merchandise or your adoption through PayPal.

The Donate button is if you would like to donate through PayPal.

**Please note that PayPal does charge a 2.9% fee with either of these.

VENMO LINK

Paypal

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