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Owner Surrender Form

At Hairy Houdini Siberian Husky Rescue we understand that circumstances change. If you would like to submit your dog for surrender please fill out the below form.  Someone from the rescue will be in contact with you.

First Name
Last Name
Home Address
Country
Address Line 1
Address Line 2
City
State
Postal Code
Dog's sex
Is the dog neutered / spayed?
If yes, please provide who the dog bit, the date the bite occurred, and what city the bite occurred in.
Has the dog ever:
If yes:
Country
Address Line 1
City
State
Postal Code
Is the dog up to date on vaccinations?
Please check all of the following which describes the dog:
Has the dog lived with children?
Would you recommend your dog live with children in the future?
Has the dog lived with cats?
Would you recommend your dog live with other cats in the future?
Has the dog lived with other dogs?
Would you recommend your dog live with other dogs in the future?
Include type of food (wet/dry/raw), how much, and how often.

I hereby acknowledge that I have been notified of and fully understand the following conditions of my relinquishment of this animal:

Enter Initials
Enter Initials
Enter Full Name