Owner Surrender

Your First Name (required)

Your Last Name (required)

Email Address (required)

Home Phone (required)

Address(required)

City(required)

State(required)

Zip

Cross Streets(required)

Preferred Method of Contact(required)
CallTextEmail

Are you able to travel within Arizona to surrender the dog if needed?(required)
YesNo

Dog’s Name(required)

Breed (or best guess)(required)

Age (or estimated age)(required)

Weight(required)

Sex (Male/Female)(required)

Spayed/Neutered? (Yes/No/Unsure)(required)

How long have you owned the dog?(required)

Where did you get the dog? (Breeder, shelter, friend, found stray, etc.)(required)

Is your dog current on vaccines? (Yes/No/Unsure)(required)

Date of last vet visit(required)

Current Veterinarian (Clinic name & city) (required)

Any known medical conditions? (required)

Current medications (include dosage if known)(required)

How would you describe your dog? (Friendly, timid, fearful, anxious, protective, aggressive, etc.)(required)

Has the dog ever bitten a person? (Yes/No – explain)(required)

Has the dog ever bitten another animal? (Yes/No – explain)(required)

How is your dog with large dogs?(required)

How is your dog with small dogs?(required)

How is your dog with cats?(required)

How is your dog with children (what ages)?(required)

How is your dog with strangers?(required)

Is your dog house-trained?(required)

Is your dog crate-trained?(required)

Does your dog guard food, toys, or people?(required)

Any separation anxiety?(required)

Any history of growling, snapping, or biting?(required)

What does your dog do when left alone?(required)

What behaviors are you most concerned about?(required)

Why are you surrendering your dog? (Be specific)(required)

When do you need placement by?(required)

Have you tried anything to resolve the issue? (Training, vet visit, behaviorist, etc.)(required)

I understand that submitting this form does NOT guarantee placement with AZCR.

I certify that the information provided is truthful and complete.