Animal House Rescue
Mechanicsburg, PA

Surrender Information

If you would like Animal House Rescue to consider accepting your dog(s) into our rescue, please submit the following application to us at Sharon@animalhouserescuepa.org

The application can be submitted as a word document, or you can copy/paste the contents of the document into an e-mail.

Please note that submission of an application is NOT a guarantee that your dog(s) will be accepted as surrender(s) into our rescue.

Before submitting an application to surrender a dog(s), please review our surrender contract, which is required if your dog is accepted as a surrender to Animal House Rescue - along with a surrender donation of $100 per dog.

Our Surrender Application is available in .PDF or .DOC formats, or you can copy/paste the text of the document below.

Surrender_Application_062015.pdf
331.1 KB


Surrender_Application_062015.doc
43.5 KB




Below is the text of our surrender application and surrender contract.  If you are unable to open/download the attachments, you may copy/paste the following into an e-mail and send to us at Sharon@animalhouserescuepa.org


SURRENDER APPLICATION

Please note that completion of this application is not a guarantee that Animal House Rescue will be able to accept the dog(s) into our rescue.  Surrenders are accepted based on a number of circumstances and you will be contacted if your surrender is accepted.

Please complete all information below and send this document, along with photos to Sharon@animalhouserescuepa.org

Date

OWNER NAME

Address:

Phone #’s:

Email Address:

DOG NAME

Breed: 

Age/DOB: 

Color: 

Gender: (Male or Female) 

Altered/Fixed:

Approximate Weight:

Scars/tattoos/microchip/injuries: 

MEDICAL:  Please provide any medical paperwork.

Veterinarian: 

Is the dog current on vaccinations? 

When was the dog to the vet last? 

Has this dog been diagnosed with any medical conditions? 

Is the dog currently on any medications? 

Reason for surrender: 

How long has this dog lived with you? 

Where did you get this dog from? 

List the dog’s likes: 

List the dog’s dislikes: 

Is your dog sensitive to touch anywhere? (Ears, feet, tail, etc) 

Is your dog sensitive about being held or picked-up? 

Does your dog enjoy being bathed or groomed? 

Dog’s training history? 

Types of training tried?  (Prong Collar, Electric Shock, Choke Chain, Treats, Clicker, Praise, Training Classes, Halti, Gentle Leader, etc.) 

What commands does your dog know: 

Has this dog ever bitten anyone? If yes, please explain. 

How would you describe your dog?  (Lap Lover, Mellow, Social Butterfly, Loner, Curious, Shy/Fearful, Active, Playful, Couch Potato)

Does your dog have any fears or anxieties?  If yes, please explain:    

How would you describe your household? (Active, Quiet, Average) 

Does your dog have accidents in the house? If yes, how often.     

Where does your dog spend most of its time?  □ Inside  □ Outside  □ Inside/Outside

Do you have a fenced-in yard?  If no, how do you potty your dog:

Does your dog climb/jump fences?   If yes, please explain the circumstances. 

How long is your dog left outside each day? 

How long is your dog left alone inside your home each day?

Where is the dog kept when home alone?

Does your dog destroy things in the house when left alone?

Is this dog crate trained? 

Do you still use a crate? 

Where does this dog sleep at night?   

Do you take your dog for leash walks?  

 If yes, how often.

How is your dog on a leash?     

What type of daily exercise does your dog receive? 

How do you correct this dog? 

What animals has this dog lived/interacted with? (Dogs, Cats, Other) 

Does this dog get along with cats?  

Has this dog ever injured/killed another animal?  If yes, please explain the circumstances. 

What is your dog’s reaction towards the other dogs? .(Friendly, Playful, Aloof, Aggressive, Easy Going, Tollerant, Dominant, Submissive, Cautious, Fearful, Shy, Plays Rough, Rambunctious, Protective, No Interaction)

Does this dog have any negative reaction to other dogs?  If yes, please explain.

Has the dog ever lived with or interacted with children? If yes, list age range:

What is the dog’s attitude towards children? 

(Friendly, Playful, Aloof, Aggressive, Easy Going, Tollerant, Dominant, Submissive, Cautious, Fearful, Shy, Plays Rough, Rambunctious, Protective, No Interaction) 

Describe this dog’s favorite game or toy:   

Does this dog enjoy:  Agility, Water, Hiking, Walks, Running, Ball, Frisbee, Toys, Tugging, Digging, Being Home Alone, Car Rides, Quiet Time …

Fears/Dislikes:  (People, Men, Women, Children, Dogs, Being Left Alone, Loud Noises, Riding in a car, Everything, Groomer, Water, Nothing, Unknown)

How does this dog respond to its fears/dislikes?  (Biting, Cowering, Hiding, Running Away, Shaking, No Obvious Sign)

Describe your dog’s idea of a perfect day:

If you could change one thing about your dog, what would it be? 

Is there anything else you would like the dog’s next owner to know? 

I understand  that a surrender fee of $100.00 (per dog) is required, made payable to Animal House Rescue, at the time of surrender if we are able to take the dog.

Please review the copy of the surrender contract as listed here below and posted on our website.

For EACH dog, Please send photos of the dog when submitting your surrender application that include a photo of the entire dog (head, body, tail) and a picture of just the dog’s face showing the eyes.

By completing this application and submitting it to Animal House Rescue, you acknowledge that all answers to all questions are, to the best of my knowledge, accurate & true, you acknowledge that you have reviewed the surrender contract listed below and understand that you will be signing this document if your dog(s) are accepted as surrenders to Animal House Rescue and that you will pay a surrender fee of $100 per dog.

Name of Person Submitting This Application : _______________________________________

Date application is submitted: __________________________________________________________

 

The following is to be completed at the time the dog is surrendered to AHR IF dog is accepted and this is NOT A GUARANTEE that dog will be accepted:

 

Date dog is surrendered to AHR: ________________________________________________

Print Name of Owner: _________________________________________________________

Signature of Owner: ___________________________________________________________

Signature of AHR Representative: _______________________________DATE: ___________

 

Once completed, please send this document, along with photos to Sharon@AnimalHouseRescuePA.org

Once completed, please send this document, along with photos to Sharon@animalhouserescuepa.org


SURRENDER CONTRACT

This is a contract between Animal House Rescue (hereinafter called AHR) and the pet owner whose signature appears below (hereinafter called “Owner”).

Owner agrees to give up all rights of possession and ownership of said dog and the Owner will not be able to redeem said dog at any time.

Owner will not be allowed to know the dog’s whereabouts.

Owner's surrendering of said dog is in exchange for evaluation and placement by AHR. 

Owner agrees that said dog is now the sole property of AHR.

Owner gives authorization to AHR to obtain veterinary records on said dog.

Owner specifically represents that s/he is the sole owner of the pet, free and clear of all liens and encumbrances.

Owner specifically represents to AHR that the pet has not been exposed to rabies or distemper within the past thirty days.

Owner specifically represents that said dog has never bitten any human, unless previously disclosed.

This Contract contains the entire agreement between the parties. All terms and conditions of this contract shall be binding on the heirs, administrators, personal representatives and assigns of the Owner & AHR.

By signing this contract and leaving his/her pet with AHR, Owner certifies to the accuracy of all information given about said pet and that AHR will not be held liable or chargeable for any false information or any misrepresentation that Owner may have submitted on this form.

A surrender fee of $100.00 (per dog) is required, made payable to Animal House Rescue, at the time of surrender if we are able to take the dog. 

Date dog is surrendered to AHR: ________________________________________________

Print Name of Owner: _________________________________________________________

Signature of Owner: ___________________________________________________________

Signature of AHR Representative: _______________________________DATE: ___________