All Those Left Behind Animal Rescue, Inc.

Surrendering Your Pet

YOU MUST COMPLETE COMPLETE ONLINE OWNER RELINQUISH FORM BELOW. WE WILL NOT DISCUSS REHOMING YOUR ANIMAL UNTIL THIS IS COMPLETE! ALLOW UP TO 10 DAYS FOR A RESPONSE

Releasing your pet to ATLB Rescue can be a difficult decision to make. We would like you to know that we understand how hard it can be to relinquish a pet. We appreciate your choice to surrender your animal responsibly so that he or she will be safe and humanely cared for.

Animal surrenders at ATLB Rescue are handled as quickly as possible. We do require you to complete the ONLINE OWNER RELINQUISH FORM BELOW before any arrangements can be made. Keep in mind we do not have a Shelter Building and we can only take in animals if we have foster homes available.

As a private, nonprofit organization dependent on community contributions, we request a monetary care donation when an animal is surrendered to us. The suggested donation range is $25-$400, although it is not required to contribute this full amount. All donations are greatly appreciated and help to offset a portion of the cost of caring for the hundreds of animals we receive each year.

OWNER RELINQUISH FORM

Your Name: (First & Last)
Spouse or Co-App Name
Address
City, State, Zip Code
Email Address:
Home Phone:
Cell Phone
Current Vet's Name, Address and Phone Number
Dogs Name
Breed
How long have you owned this dog?
Why is dog being relinquised? Explain in great detail!
Is this dog housebroken?
If yes, how does he tell you he needs to go out
If no, please explain in detail how often accidents occur
How have you delt with this problem?	Paper trained Crated Checked w/vet for medical problem Allowed dog in certain areas Kept dog outside Diapered Just dealt with it
Are accidents usually
Has your dog attended any training classes?
If yes, what types	puppy class obedience class home training agility protection
Does your dog know any tricks?	sit stay come lie down heel walk nicely on leash ride quietly in car Fetch Other
Explain other tricks
Does the dog get into trash if unsupervised?
Will the dog get onto counters if unsupervised?
This dog is frightened of	men women teenagers children thunder fireworks vacuums sirens appliances trucks water hands feet boots rolled newspaper Other
Explain other
Is there anything that would make this dog show aggression towards people?
If yes, please explain in detail
Is your dog up to date on vaccines? And can you prove it?
County Vaccine was Given
Rabies Tag #
Additional Vaccines & Date Given
Is your dog on heart worm preventitive?
If yes, what brand and last date given?
What is the last date a heartworm test was done?
Male or Female?
Has your dog already been fixed?
Is your dogs ears cropped?
Is your dogs tail docked?
Age or birthdate of dog?
Upload a recent photo
Is your dog micro-chipped?
If yes, What Brand and Chip #
Where was this dog aquired?	Shelter - Rescue Friend - Family Pet Store Newspaper - Online Found - Stray Born at Home
If shelter - rescue, provide the name of the shelter - rescue?
If from a breeder, provide name of breeder
Please describe in detail this dogs personality
What is your level of expertise with dogs?
Where was the dogs MAIN living area?	Whole House Kitchen Basement Backyard Crate Garage Tied outside
Explain in detail the number of hours the dog was kept inside / outside / unsupervised
Where was the dog kept when home alone?	Crate Run of house Laundry room Kitchen Garage Outside Basement
What is this dogs outside behavior?	digging barking at outside interests barking to come in chewing plants Visiting neighbors Using small pool Jumping at fence Jumping over fence Digging under fence Sunbathes Plays with toys Howls
If loose, your dog will	Stay in yard Stay in yard only if owner Present Wander to the neighbors Pester neighborhood animals Get into the garbage Come home on its own Run away
Dog will chase	People Children Vehicles Joggers Bicycles Cats Skateboarders Rollerbladers Livestock Birds Wildlife A Ball A Frisbee
Did this dog interact with other pets?
If yes, please explain in detail his temperment with both
Who did this dog live with / interact with?	men women seniors Infant Children ( Birth - 8 yrs) Children (10 and under) Children (10 and up)
Where did this dog sleep?	Owners’ bed Owners’ bedroom Dog bed Couch Garage Crate Porch Outdoors
Please list ages of children (seperated by commas)
Select the dogs behavior around adults	Friendly Shy Playful Fearful Aggressive Snappy Tolerant Overly affectionate Over protective
Please describe an example of behavior around adults
Select the dogs behavior around kids	NEVER BEEN WITH KIDS Friendly Shy Playful Fearful Aggressive Snappy Tolerant Overly affectionate Over protective
Please describe an example of behavior around kids
Many children are bitten by dogs each year, would you recommend that this dog be placed with a young child?
If No, what age groups do you recommend for this dog?
If a child goes near the dog when it is eating, chewing a bone, playing with a toy, would the child be in danger
If yes, please explain
Has this dog ever bitten, snapped or growled at anyone?
If yes, explain in DETAIL
Please explain in detail the BEST qualities - traits dog has.
Your Age Group
Are you prepared to pay a owner surrender fee for the ongoing care and medical needs of this dog until their forever home is found?
If yes, what amount are you comfortable donating for the vetting an ongoing care of this animal until it can be placed in its forever home	$None$ $25 $50 $75 $100 $150 $200 $300 $400
Please give us 1 NON family reference. Name, phone number, address and relationship:
Please give us 1 family reference. Name, phone number, address and relationship:
How did you hear about ATLB Rescue?
As owner, or custodian acting in good faith, I give the above-described animal irrevocably to All Those Left Behind Animal Rescue, Inc. or whatever disposition All Those Left Behind Animal Rescue, Inc. deems best. My signature waives any and all further rights of ownership to this animal. I understand that All Those Left Behind Animal Rescue, Inc. has NO further obligation to inform me of this animal’s final disposition or furnish me with any information on the new adoptive home of this animal.