Canine Surrender | Welcome to Wayside Waifs

Canine Surrender Application

Pet Owner Information

Pet Owner Name*

First Last

Email*

Address*

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

Phone (please include area code)*

Are you the owner of the dog? If not, what's your relationship with the owner?*

Have you adopted from, donated to, or surrendered another animal to Wayside Waifs in the past?*

Pet's Description/Information

Pet's name:*

Pet's age:*

Breed:*

Gender:*

Is your pet spayed or neutered?*

How much does this pet currently weigh?*

Where did you get this dog?*

If you chose "Adopted from another shelter/rescue", which one?

Have you tried reaching out to that shelter?

Yes
No

How long have you owned this dog?*

What is the MAIN reason you are surrendering?*

Please explain further if needed (optional):

Are you interested in troubleshooting options to keep your pet in the home?*

Yes
No
Maybe

How long can you continue to safely care for the pet?*

Pet's Medical Information

Name of veterinary clinic:*

Does your pet have any ongoing or current medical concerns?*

If yes, please describe:

Has your pet been diagnosed for anything by a veterinarian?*

If yes, please describe:

Is your pet taking any medications and/or on a special diet?*

If yes, list medications or prescribed special diet:

If your dog has been seen by a vet, how do they do for medical handling such as blood draws, receiving vaccines, and just generally being handled?*

Has your vet ever spoken to you about your pet needing to take medication prior to visiting?*

Yes
No
N/A

Behavioral/Personality Questions:

How would you describe your pet's personality? (Gentle, friendly, nervous, etc.)*

Your dog has lived with:*

Has this dog ever bitten a person? If no, skip next 5 questions.*

Did the bite draw blood?

Has this dog bitten a person in the last 10 days?

Date of most recent incident:

Describe the incident(s) using as much detail as possible:

Has your dog ever bitten another animal? If no, skip next 6 questions.*

Date of most recent incident:

Species of other animal (dog, cat, etc):

Did the bite draw blood?

Yes
No

If yes, did the other pet receive medical care for injuries?

Is the other animal deceased?

Yes
No

Describe the incident using as much detail as possible:

How does your dog do when meeting a) strangers in the home and b) strangers outside the home?*

How does your dog do with other dogs a) on a leash and b) off leash?*

How does your dog react to being left alone?*

Has the dog consistently used and currently use a crate while within the home?*

Yes
No

If yes, and if the dog is crate-trained, which kind of crate?

Wire/Metal
Plastic
Other

If yes, how does your dog react to being crated?

If no, have you tried crating the dog? How did that go?

Does your dog escape the property?*

Yes
No
Occasionally

If yes, or occasionally, please describe the situation in which your dog escapes and how you've tried to mitigate the issue:

When your dog is eating food, treats, or has a special toy and is approached by a person they:*

Growl
Show teeth
Lunge
Take the item and walk away
Drop item and walk away
No reaction

When your dog is eating food, treats, or has a special toy and is approached by another dog they:*

Growl
Show teeth
Lunge
Take the item and walk away
Drop the item and walk away
No reaction

Personality, Misc. Info

The following questions are optional to submit this application, but if your pet is accepted we may ask for these questions to be completed before your appointment.

In an ideal world, what level of exercise would your dog enjoy getting every day?

What are some awesome things about your pet?

Does your pet have any bad habits?

How does your dog do on car rides?

How does the dog act when they see things like bicycles, skateboards, strollers, or cars passing them?

What are some things your dog LIKES?

What are some things your dog DISLIKES?

Is there anything else you want us to know about your pet?

Household Safety/Wellness Information

Has anyone ever threatened to harm/harmed your pet(s)?*

Has anyone ever threatened to harm/harmed you?*

Do you feel safe in your home?*

Please upload (1) image of your pet. Image should be in focus and show the animals face and body.

Max. file size: 50 MB.

Upload image.

Comments

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