Surrender Request This form is a surrender of ownership. Please answer questions candidly and honestly. This form becomes legally binding once accepted by MHCR. Many times issues with a dog can be resolved with professional assistance. Click the button below for resources and recommendations. Behavior & Training Resources Surrender Request Form Date* Date Format: MM slash DD slash YYYY Owner's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Dog's Name* First Breed*Sex*Choose OneMaleFemaleAge of Dog*Is your dog spayed or neutered?Choose OneYesNoIs your dog UTD on vaccines?Choose OneYesNoHow long have you had this dog?*Was this dog adopted?*No, I did not adopt this dogYes, but not from MHCRYes, I adopted him/her from MHCRWho did you adopt the dog from?*Why are you surrendering your dog?*Please be as specific as possible. Examples include job change, move, behavior issues (specify), lack of time, inability to contain, doesn't get along with dogs, needs training (be specific).Do you want to keep your dog while we look for a home?*Choose OneYesNoHow quickly do you need your dog out of your home?*ImmediatelyWithin the weekWithin 2 weeksWithin a monthI'll keep my dog until a suitable home is foundHas your dog ever bitten a human?*Choose OneYesNoIf yes, please provide details:*Has you dog ever bitten another dog?*Choose OneYesNoIf yes, please provide details:*Please mark all that apply:*My dog: is friendly with other dogs hasn't really been around other dogs is friendly with cats hasn't really been around cats is good with kids shouldn't be with kids needs to be the only pet in the home is house trained has accidents in the house or marks things is crate trained is trustworthy free roam jumps fences has separation anxiety is destructive if left alone is growly with new people has a high prey drive guarding of food/toys/resources Has your dog ever killed or seriously injured another animal?*Choose OneYesNoIf yes, please provide details:*Please provide any additional information you'd like to give us.Please upload a pic(s) of your dog that clearly shows its face.* Drop files here or Please upload vet records. Drop files here or By signing my name below, I certify that I am the legal owner of the above described canine. I surrender all claim of ownership to the above described dog to Mile High Canine Rescue without recourse. I will make no effort to reclaim the above described canine. I have supplied truthful information to the best of my knowledge.I understand that I have chosen to act as a foster for my dog while it is being placed for adoption. I am doing so at my own risk. I agree to reimburse Mile High Canine Rescue, Inc. for any costs incurred by them for my dogs vetting or care if for any reason the dog is not adopted out by Mile High Canine Rescue. Further, I forever release Mile High Canine Rescue and its' directors, officers, volunteers, and assigns from any and all liability and/or claims (whether personal property, injury, or medical) associated with my dog.I understand this Surrender Form must be accepted by Mile High Canine Rescue, Inc. before it becomes legally binding.Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Signature*