Dog Surrender Profile | Greater Androscoggin Humane Society

Your Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

What is your dog's gender?(Required)

Spayed Female

Non-spayed Female

Neutered Male

Non-neutered Male

Photos(Required)

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Please share a photo of the animal.

Medical Records

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Please share any veterinary records.

Name of Dog

Age of Dog(Required)

Please indicate approximate months or years

Breed, if known(Required)

If this dog has been to a Veterinarian, which clinic?(Required)

Is this dog up-to-date on vaccines?(Required)

Yes

Unknown

Was the dog adopted from GAHS?(Required)

Yes

Unknown

Please explain why you need to surrender your dog.(Required)

If there is anything we can do to help you keep your dog, what would it be?(Required)

Have you attempted to rehome your dog on your own? Please explain.(Required)

Does this dog have special needs or conditions?(Required)

Medical conditions

Behavioral concerns

Other

Please describe any special needs/medical conditions.

Dog has lived with:(Required)

Adults

Teenagers

Children under 12

Dogs

Cats

Other Animals

Please tell us about the relationship your dog has with other animals in the home, including any challenges/issues between them.(Required)

How did this dog come into your care/home? What can you tell us about any prior homes the dog has had?(Required)

What does your dog do when they meet a person they do not know? How do you respond to the dog? Is there a difference in how the dog responds to meeting a new person outside the home versus inside the home?(Required)

Tell us about how your dog reacts to children. Is there a difference between meeting children outside the home versus inside the home? Please tell us about it and what you do if the interaction is not what you like.(Required)

Has your dog ever played with other dogs? Tell us about your dog’s playstyle and friends outside the home. How does your dog react to new dogs when on a leash?(Required)

Is your dog housetrained?(Required)

Yes

Partially

Does your dog ever try to chase moving cars, bicycles, cats, rabbits, squirrels, etc.? Please explain(Required)

Has your dog ever growled, snarled, or snapped at another person or animal? Please describe those incidences and what your reaction was to your dog when this happened.(Required)

Have you utilized training for your dog?(Required)

Yes, professional

Yes, non-professional

If your dog has had training, please describe. What methods were used? Who did the training? Was the training successful? How so?(Required)

Has your dog ever bitten or nipped another person or animal? If so, please explain the incidents and what you did in response. Did any bites draw blood or serious injure a person or animal?(Required)

What does your dog’s typical diet consist of? How many meals a day? Any treats, snacks, bones, etc?(Required)

What do you love most about your dog? Least? Please explain.(Required)

Dog Intake Form