Surrender Form

Owner Surrender Questionnaire
Thank you for contacting the Rappahannock Animal Welfare League regarding rehoming your
pet. This questionnaire helps us better understand your animal’s needs, temperament, and
medical history so we can make the best possible decisions for their care and placement.
Please complete all sections honestly and thoroughly. Submission of this form does not guarantee
acceptance into the rescue.

Surrender Form

Contact Information

First name

Last name

Email

Phone Number

Address

City, State, Zipcode

Best way to contact you:

Phone

Text

Email

Pet Information

Pet's Name:

Species:

Dog

Breed or Mix:

Age or DOB

Sex:

Male

Female

Spayed/Neutered:

Yes

No

Weight:

Colors/Markings:

How long have you owned this pet?

If you selected "other" for the question above, please describe:

Reason for Surrender

Please explain why you are seeking to surrender this pet:

Have you attempted any alternatives to surrender? (Check all that apply)

Yes

No

Please list name of rescue if you selected "return to rescue" for the question above:

Health and Veterinary Information

Name of Veterinary Clinic

Clinic Phone Number:

Is your pet current on vaccines?

Yes

No

Unsure

Date of last rabies vaccine:

Current medications:

Any known medical conditions?

Has your pet ever bitten or scratched a person or another animal?

Yes

No

If so, please explain:

Questions

Is your dog housebroken?

Yes

No

Mostly

Is your dog crate trained?

Yes

No

Mostly

How does your dog behave around CATS?

Good with cats

Chases cats

Aggressive toward cats

Unkown

Activity level:

Low

Moderate

High

Describe your daily routine:

Temperament & Personality

Please describe your pet's personality:

Favorit activities/toys:

What commands or skills does your pet know?

What type of home do you think would be best for your pet?

Photo & Records

Please attach the following:

Recent photos

Vaccination

Spay/neuter records

Behavioral or training records (if applicable)

Recent photo

Vaccination

Spay/neuter records

Behavioral or training records

Thank you for completing the surrender questionnaire. A representative from Rappahannock Animal Welfare League will review your submission and contact you as soon as possible. Please understand that rescue space and foster availability are limited, and completion of this form does not guarantee intake.

I certify that the information above is true and understand that false information will result in nullification of this form.

Signature

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Surrender Form

Surrender Form

Questions

Temperament & Personality

Photo & Records

Reminder: RAWL is a non-profit IRS 501(c)(3) organization.

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Registered Charity Number : 54-1568203