Surrender Form – Dog(s) Surrender Form - Dogs HiddenSurrender Form - Dog(s)Please fill in the below form to arrange to surrender your dog(s). Once you finish the form and hit submit, the form will be sent to our Adoption & Intake Coordinator. They will reach out to you to arrange an appointment for surrender as soon as they're able to. Please be aware that forms submitted after 530pm and/or on weekends will not be answered until the next working day.Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Email Phone(Required)Why are you surrendering your dog?(Required)Your dog's name(Required) Breed(Required) Age(Required) My dog is(Required) Male Female Unsure My dog is spayed or neutered(Required) Yes No Unsure How long have you owned your dog? When did your dog last see a veterinarian and what was the reason for the visit?(Required) When was your dog last vaccinated and what vaccines were given?(Required) Which veterinary clinic(s) has your dog visited?(Required) Vet clinic's phone numberAs legal owner of the above animal, I authorize the above vet clinic to release the records pertaining to the veterinary care and medical history of this animal to the PEI Humane Society. Yes No Does your dog have any medical issues? Is your dog taking any medications or require any special diets?(Required) What food do you feed your dog? How often? What treats do they like?(Required) How does your dog react when you go near his food bowl? How does your dog react when you approach him when he has a bone or toy?(Required)Is your dog house-trained? What is the dog's potty schedule in your home on a typical day?(Required)Has your dog ever lived with or spent time with any of the following? Children Other Dogs Cats Other In your opinion, as the person that knows this dog best, is your dog a threat or a danger to...(Required) Children Other Dogs Cats Wildlife (squirrels, foxes, crows, etc) Farm animals (chickens, rabbits, etc.) All people Just men Just women Strangers at the door/on the property People when he has food, a bone, etc. No one I am unsure and nervous about this dog. But he has never hurt anyone, and I need your help to decide what is best. Does your dog like driving in the car? Yes, loves the car No, gets upset and cries in the car No, he gets car sick Other Does your dog like the beach? Yes, and loves to swim Yes, but he just walks the beach and hates the water No Has your dog ever growled or snarled at anyone? If yes, please explain the circumstances in detail.(Required)Has your dog ever nipped or broken the skin on anyone? If yes, please explain the circumstances in detail.(Required)Has your dog ever injured another animal?(Required) No Another dog Cat Wildlife Other What is your dog's favourite game, toy or pass time?(Required)Was your dog ever kennel/crate trained?(Required) Yes No For what reason was your dog kennel/crate trained? My dog knows commands for...(Required) Sit Down Off Come Stay Shake a paw Roll Over Some others but I'll explain them during my appointment My dog knows no commands I have used the following methods to train my dog...(Required) Treats & praise Choke chain/prong collar Shock collar Electric underground fencing Shouting Hitting (either with hand, foot, or instrument such as a broom) Alpha roles (pinning the dog) Clicker/Marker training Training classes Some others but I'll explain during my appointment My dog has never had any training I walk my dog at...(Required) Nylon or leather buckle collar Choke chain or slip collar Shock collar or electronic collar Prong or pinch collar Martingale collar Gentle leader or Halti Traditional harness Easy-Walk or No-Pull Harness Other My dog has never been walked on a leash What kind of family would be best for your dog and why? If you do not think your dog can or should be rehomed, please explain why.(Required)Is there anything else you would like to add that would be important for shelter workers, volunteers and potential new adopters to know about your dog?By checking this box, I certify that I understand that an employee of the PEI Humane Society will contact me soon using the information (phone number, email, etc.) that I have provided above regarding surrender of my pet. I certify that this information is correct.(Required) Yes
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