First Name*
Last Name*
Address
City
State/Province
Zip/Postal Code -
Email*
Home Phone
Cell Phone
What is your pets name?*
What breed or mix is your pet?*
What is the gender of your pet?
How old is your pet?*
What colour is your pet?*
Where did you get your pet, and how long have you had it?*
Is your pet spayed/neutered?
Are your pets vaccines up to date?
If your pet is up to date with vaccines, please list date completed as well as which vaccines were provided. If your pet is not up to date on vaccines, please list the last date vaccines were done.*
Is your pet currently on flea or heartworm prevention? Choose all that apply: Yes No Flea prevention Heartworm prevention
Please provide the name, address and telephone number of your current veterinarian, as well as the date of your last visit. Please note that you will have to provide permission for a Hank's representative to speak to your clinic regarding your pet.*
Has your dog had previous training, either obedience or behavioural?
Is your pet house trained? Crate trained?*
Is your pet good with kids?
Is your pet good with other animals? (dogs, cats)*
Does your pet exhibit a prey drive (chasing small animals)?
How does your pet act on their leash? Do they pull, do they show reactivity to other dogs or people?*
Has your pet ever bitten another animal?
Has your pet ever bitten a person?
Does your pet currently have a muzzle order, or had a muzzle order in the past due to a bite?
Why do you want to surrender your pet to Hank's Haven. Please include as much information as possible in order to help us understand your pet.*
Are you willing to have a Hank's Haven representative do a behavioural assessment on your dog prior to surrender?
Are you willing to donate a surrender fee of $500 to help offset vet fees or training fees? Please note that this is a base fee. Hank's Haven is a not for profit rescue, and we need to know of any and all health or behavioural issues. If our vet or trainer uncovers issues that were not previously disclosed we may ask for a further donation to help support the care and training that your pet will require.
I hereby certify by my signature below that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this animal surrender form. I hereby surrender any and all rights to the animal to Hank's Haven Rescue Foundation for rehoming. I certify that no other person has a right of property to the animal.*
