Surrender Form

Today's Date

First name

Last name

Email

Phone

County and State that the owner and dog live in?

I understand that Al-Van does not provide boarding to any pets. If I surrender my pet to Al-Van, I am relinquishing ownership of my pet to Al-Van and will not be able to reclaim ownership of the

pet.

I understand that submitting this form does not guarantee that Al-Van will be able to take in my pet and I will need to seek out other available resources.

I understand that if Al-Van Humane Society is able to accept my pet as a surrendered animal into their shelter, a surrender fee of $35 will be required and collected when I surrender my pet. Animals may not be surrendered to Al-Van Humane Society prior to the $35 fee being collected.

I understand that I will receive an email response within 3 business days to inform me I have been approved to surrender my pet to Al-Van.

Are you the current owner of this pet?

Yes

No

Dog's Name

Is the dog male or female?

Male

Female

Is the dog spayed or neutered?

Yes

No

What is the dog's breed? (a guess is okay, mixed will not be accepted)

What is the dog's age? (an estimate is okay, unknown will not be accepted)

What is the dog's current weight? (unknown will not be accepted)

Is the dog up to date with vaccines as far as you're aware? If so, you will be asked to provide proof of vaccinations.

Yes

No

Unknown

Please list any medical concerns.

Please list any medications this pet is currently taking.

Please list any behavioral concerns.

Is the dog housebroken?

Yes

No

Is the dog crate trained?

Yes

No

How long has this dog been in your possession?

Has the dog ever bitten anyone? If so please describe the situtation and if the person required medical treetment.

Has the pet ever attacked or killed another animal? If so, please describe the situation and what kind of animal it was.

How does the dog do with children? (under the age of 10)

They DO WELL with children.

They DO NOT do well with children.

They have not been exposed to children, but I suspect they would DO WELL.

They have not been exposed to children, but I DO NOT think they would do well.

How does the dog do with other dogs?

They DO WELL with ALL other dogs.

They DO NOT do well with other dogs.

They have not socialized with other dogs.

How does the dog do with cats

They love cats.

They DO NOT do well with cats.

They have not been socialized with cats.

Please provide a detailed explanation as to why this pet needs to be surrendered/rehomed?

Please provide a detailed explanation of all of the actions you have taken and resources you have sought out to try to provide a successful home for this pet.

What type of energy level does the dog have?

Low (happy sleeping on the couch all day)

Moderate (playing in yard is enough)

Medium (does best with daily walks)

High (NEEDS daily walks or runs)

Please upload a picture of the dog.

Assessment & Intake Process Acknowledgment

I understand that if I receive an “Accepted” response, an Al-Van Humane Society representative will contact me to schedule an appointment for a physical and behavioral assessment of my pet.

This assessment will determine whether my pet is considered a candidate for intake at Al-Van Humane Society. I acknowledge that there is a possibility my pet may not pass the assessment and therefore may not be accepted for intake.

I understand that Al-Van Humane Society cannot provide a specific timeframe for when this assessment will occur, as scheduling is dependent upon available space and current shelter capacity."

Surrendering Your Pet

Assessment & Intake Process Acknowledgment

Dog Surrender Form