Owner Relinquish

Owner Relinquish Applications

At Last Hope Animal Rescue we feel it is extremely important for animals to remain in their original homes if at all possible.  Here is a wonderful resource for ways to keep your pet.
However, when all else fails, certain circumstances dictate that an owner must relinquish their animal. To start this process please fill out the below form. Please allow us at least 24-48 hour to receive and review your application before someone contacts you.

Personal Information

1. Your Name(required)
2. Address(required)
3. City
4. State
5. Home Phone(required)
6. Cell Phone(required)
7. Email(valid email required)
8. Alternate Email(valid email required)

Dog's Information

1. Dog's Name(required)
2. Dog's Breed or mix(required)
3. Dog's Age(required)
4. Dog's Sex(required)
5. Dog's Weight
6. Is the dog housebroken(required)
7. Groomer Used for Dog

Veterinarian's Information

1. Veterinarian's Name(required)
2. Veterinarian's Address
3. Veterinarian's Phone Number(required)
4. Is the dog spay or neutered(required)
5. Health Issues

Vaccination Information

1. Give date of last vaccinations for each shot listed below
2. Rabies
3. Distemper
4. Parvo
5. Lyme's Disease
6. Bordatella
7. Heart Worm
8. Heart Worm Results
9. Positive Negative
10. Has the dog been on Heartworm preventative
11. Yes No
12. Last Date Heartworm preventative given
13. Has the dog been on Flea/Tick preventative
14. Yes No

Animal Behavior Information

1. Last Date Flea/Tick preventative given
2. How does the dog react to small children(required)
3. How does the dog react to older children, men and/or women:(required)
4. Is the dog used to a fenced in yard or lead (tie out):
5. What food does the dog eat? Brand and amount per day
6. What treats does the dog like
7. What special places does the dog liked pet/rubbed
8. Where does the dog sleep(required)
9. Where is dog when you are gone? Inside, Outside, free roam in or out, crate, etc
10. What is the dog afraid of? Thunderstorms, fireworks, car rides, etc
11. How does the dog react to cats(required)
12. How does the dog react other dogs(required)
13. Does this dog have a bite history
14. Yes No
15. If the dog has a bite history, describe incident(s), bit person, other pet, number of incidents etc
16. Reason for need to surrender dog(required)
17. Photo of the Dog

 

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