Canine Surrender Request

The Humane Society at Lakewood Ranch is a 501(c)3 non-profit, no-kill animal rescue and shelter, that provides assistance and care for at-risk animals until forever homes can be found.

Our hope is to help keep owners and pets together through counseling and assistance.  if surrender is your only remaining option, our shelter manager will review the behavior and medical information provided.  If we believe we can accommodate your surrender request, we will contact you within one week to schedule an appointment to meet and evaluate your pet in person.

Please contact us at least 24 hours proir to your scheduled appointment should you need to cancel or reschedule.  An appointment does not guarantee acceptance into our adoption program.  If your pet is not a candidate  for our adoption program and we cannot accommodate your surrrender request, you will be notified within one week of receipt of your request.

Animal Information
Spayed/Neutered:
Animal Name:
Breed:
Age:
Color:
Weight:
Microchipped?:
How long has this dog lived with you?:
Where did you acquire this dog?:
Reason for surrender:
Owner Information
Full Name:
Address:
City:
State:
Zip:
Phone:
Email:
Medical History
Has your dog visited a veterinarian?:
If yes, date of last visit:
Name of Veterinarian:
How does your dog act at the vet office? Does it need to be muzzled?:
Please list all medications your pet is taking:
Does your dog have any skin issues?:
Does your dog have any lumps or bumps?:
Does your dog limp?:
Any other medical issues:
Animal Behavior
Check all that apply
Aggressive:
Destructive:
Lives Outside:
Nervous:
Depressed:
Hyperactive:
Playful:
Excitable:
Demands Attention:
Disobedient:
Noisy/Excessive Vocalization:
None:
Where does your dog spend most of his/her time?:
When your dog is left alone, your dog is:
Is your dog house broken?:
Is your dog crate trained?:
Does your dog get along with other dogs?:
If no, please explain:
Does your dog get along with cats?:
Has your dog ever harmed another animal?:
If yes, please explain:
Has your dog ever bitten a person?:
If yes, please explain:
Please check all that your dog is afraid of:
Thunder:
Loud Noises:
Strangers:
Men:
Women:
Children:
None:
Your dog will guard which of the following:
Food:
Family:
House:
Property:
Toys:
None:
What type of training have you done with your dog? Have you been to a class? If so, where?:
Does your dog do tricks (sit, roll over, etc.)?:
How do you correct your dog if they misbehave?:
How is your dog on a leash?:
Can you take food away from your dog?:
Can you take toys away from your dog?:
Does your dog allow strangers in your home?:
If no, how does your dog react to strangers?:
Is your dog easy to groom (brush, trim nails, clean ears, etc.)?:
If no, please explain:
Would your dog be ok if placed in a home with small children?:
If no, please explain:
Feeding
How many times a day do you feed your dog?:
How much do you feed your dog daily?:
What brand and type of food do you currently feed them?:
If I could change one thing about my dog it would be:
I would keep my dog if: