Surrender Form - LVHDDCR

Member Log In

Special thanks to our
sponsor:

Surrender Form

Please complete the form for each individual dog you would like to surrender

First Name:

Last Name:

Email Address:

Address:

Home Phone:

Cell Phone:

About Your Dog:

Name of your Dog:

Age?

Gender? Male Female

Spayed/Neutered? Yes No

AKC Papers? Yes No

Purebred? Yes No Not Sure

Microchipped? Yes No

Housebroken? Yes No

Up-to-date on Shots? Yes No

Good with Children?

Good with Dogs?

Good with Cats?

Color/Coat?

Obedience Training?

Bad Habits?

Health Problems?

Where did the dog come from?

Reason for not keeping the dog?

Bitten Anyone?

Veterinarian Info:

Name of Vet?

Vet Phone Number?

Vet Address:

Vaccines Due:

Photos: (Photo Upload is Optional - Files must be .jpg or .jpeg format)

Photo 1:

Photo 2:

Due to the expense of placing your pet (Veterinary bills, transportation, advertising, food, phone calls, supplies, etc.) would you be willing to make a donation? And if so, how much can you donate?

If your dog has not been spayed/neutered, microchiped, vaccines due,etc. Would you be willing to remedy these issues prior to surrendering?

Anything else you would like to add?

I surrender ownership and all claims to the above mentioned dog to Las Vegas Hot-Diggity Dachshund Club and Rescue

Owner Signature: (Enter your name to sign)

Website by: Weston Web Creations

Logo Designed and Illustrated by Sandie Friedland, Artist/Illustrator
Furevermine(R) - Paintings for Paws - www.furevermine.com