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501c3 non-profit organization in CONNECTICUT
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Fostering a Rescue Dog
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SubFostering
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Volunteering Choices
Transportation
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Support Us
Information
Transport Services
Health
Clinic Locations
Vaccination Requirements
Spaying/Neutering
Education
Dog Food
Myth of Normal Dogs
Buying A Pet
Safety
Microchip
Toxic Foods For Dogs
Pet-Friendly Places
Pet Friendly Rents
Pet Friendly Guide
Pet Friendly Groomer
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ALL DOG LISTINGS
Available Dogs
German Shepherds
Tails of Success
Applications
Adopting a Rescue Dog
Fostering a Rescue Dog
Fostering
SubFostering
Volunteering
Volunteering Choices
Transportation
Owner Turn-In
Support Us
Information
Transport Services
Health
Clinic Locations
Vaccination Requirements
Spaying/Neutering
Education
Dog Food
Myth of Normal Dogs
Buying A Pet
Safety
Microchip
Toxic Foods For Dogs
Pet-Friendly Places
Pet Friendly Rents
Pet Friendly Guide
Pet Friendly Groomer
About Us
Contact Us
Owner Turn-In Application
Owner Turn In Application
ATTENTION
All required forms must be submitted in order to process your application. We will not contact you and let you know that you are missing the documents we need. Please review the owner turn in process on our website if you are unclear about requirements.
REQUIREMENTS
If we don't receive 1) application; 2) dog intake form; 3) five photos of your dog; 4) call your vet and release your records, then your application will be filed.
Dog Name
*
What is your dogs name?
How long have you been considering doing is?
First Name
*
Last Name
*
Age
*
Mobile Phone
Home Phone
Work Phone
Apt, Suite, Bldg.
Optional
Street Address
*
Email
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Applicant Employer
*
Applicant Occupation
*
Applicant Work Schedule
*
Co-Applicant
First Name
Last Name
Age
Mobile Phone
Work Phone
Relationship to Applicant
Email
Employer
Occupation
Work Schedule
Background
How did you hear about us?
Friend
Internet
Family Member
Other
If other, please list here
*
What is your timeframe?
*
Where else have you applied?
Please list organization name
Why do you want to surrender your dog?
Be as specific as possible.
Previous Dogs You Have Owned
Have you ever owned a dog before? *
Yes
No
Were any of them a rescue dog?
Yes
No
Where did get your previous animals?
List name, city & state of organization
Have you had other animals before?
Bird, horse, etc.
How long have you had each animal?
For each animal you own, please list:
Breed
Sex
Age lived
Have you ever
Had a pet become lost?
Had a pet poisoned?
Had an animal killed by a vehicle?
Have you ever
Had an animal die or die due to disease?
Sold, given away, or surrendered a pet to a shelter?
IF YES, TO ANY OF THE ABOVE, EXPLAIN IN DETAIL
YOUR APPLICATION MAY NOT BE CONSIDERED FURTHER WITHOUT ADEQUATE DETAIL
Current Pet(s) In Your Household
For each animal that you own, please list:
Pets Names
Breed
Age
Gender
Spayed or Neutered
What food(s) does your current dog eat?
How often?
Are all pets up-to-date on vaccinations?
RDV will close your application if all information is not accurate.
Yes
No
If "no," please explain why not.
List preventative treatments current pets receive and frequency of dosage:
Have you and your dog gone to training? Describe your experience and if you accomplished your objective.
Have you had any other training previously with other pets? Describe your experience and if you accomplished your objective.
Dog Care Informaiton
How often was your dog exercised?
Was your dog left unattended outside?
Was your dog allowed to be off-leash?
Do you use a tie out or runner for your dog?
Yes
No
If yes, you MUST explain how and when it is used:
How many hours a day on average was the dog home alone without adults?
Is your dog primarily kept:
Indoors
Outdoors
Where is the dog kept when no one is at home?
Is your dog:
Blocked-off portion of the house
Have the run of the house
Be crated
Be tied or attached to runner outside
Be kept in a dog house
What provisions do you make for your dog during those times?
Where does your dog sleep?
Household
Do you live in a:
*
House
Townhouse
Duplex
Condo
Apartment
Other
Do you have a yard?
Yes
No
What is the size of your yard--area for dog?
Is it completely fenced?
Yes
No
What is the height and type of fence?
Dog safety and excercise plan
If no fence or partial fencing how is your dog allowed to exercise, play, and relieve him/herself while being kept from running away, getting lost, or getting hurt?
Renters
YOU NEED TO COMPLETE THIS SECTION IF YOU RENT YOUR RESIDENCE
Do you rent or own?
*
Rent
Own
Did you obtain permission to keep a dog from your landlord?
Yes
No
YOU WILL NEED TO PROVIDE YOUR LANDLORD’S NAME AND CONTACT INFORMATION OR WE WILL NOT BE ABLE TO PROCESS YOUR APPLICATION
Landlord's Name
Name of Landlord or Housing Manager
Company Name
Name of Apartment or Company
Phone
Landford Email
Apt, Suite, Bldg
Optional
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Children & Household Members
PLEASE NOTE: WE DO NOT RECOMMEND YOU INVOLVE YOUNG CHILDREN IN THE PROCESS UNTIL THE PROCESS IS COMPLETE. IT IS YOUR RESPONSIBILITY TO PROTECT YOUR CHILDREN FROM BEING HURT OR CONFUSED IF AN ADOPTION DOES NOT HAPPEN.
How many children in the house?
Ages of children in the house
Describe their (children’s) experience/exposure to large dogs:
How often do you have young children visit (grandchildren or friends of children)
If you have children, what precautions will you take to ensure children and the dog(s) can co-exist safely?
How many adults in the household?
Other then applicants
Ages household members in the household
Other then applicants
Relationship other household members to applicant(s)
Did everyone in your household want the dog?
Yes
No
Who is responsible for the care of the dog?
Who is responsible for the training?
How are the children and household members involved with care of dog?
Current Vet Information
CALL YOUR VET
You must call your vet and give permission for us to speak with them. All vet records must be obtained from the vets office
Current Vet Name
*
Organization
Phone
Apt, Suite, Bldg
optional
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Previous Vet Information
Past Vet Name
Organization
Phone
Apt, Suite, Bldg. (optional)
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Getting To Know You
Why is this question essential?
The application you just completed is very important because the questions tell us all about your life. The question below helps us get to know you and in many cases helps us with our decision. You could be wonderful but we won't know unless you tell us here.
Here are some suggestions:
If you had dogs before, what was that experience like that moved you?
What were the events that made you come to this decision?
What did your dog do for you and most important, what did you do for this dog.
Most Important Question
Please use this space to tell us anything about you which you think may be helpful. Here is your chance to tell us why you need to turn surrender your dog.
TERMS AND DISCLOSURES
Dog Assessment
Allow a rescue volunteer to assess your dogs behavior?
I agree
Provide Accurate Information
Agree that all the information you have provided us is truthful and accurate.
I agree
Call Your Vet
You will call your vet and give them permission to speak with us right after your application is submitted.
I agree
Return Your Dog
We reserve the right to return the dog at any time should we find that you have withheld information from us and/or that the information you provided to us is not true.
I agree
Accuracy of information provided
We reserve the right to withdraw RDV's commitment at any time should we find that the any of the information provided on this questionnaire is not true or information has been withheld.
I agree
Authorization
By submitting this form I hereby authorize a Rescue Dog Village Guardian, Inc. representative to verify all information provided on this form and give your veterinarian permission to disclose all medical information requested.
I agree
Signature
By entering my signature here, means I have agreed to all the terms in this form and agree that Rescue Dog Village Guardian, Inc. are released and indemnified from any and all claims, known or unknown, now or hereafter arising in connection with any dog placed in your home.
I agree
Submission of an application DOES NOT guarantee RDV will take your dog into our program.
I agree
Signature
*
Enter your full, legal name.
Verification
Please enter any two digits
Example: 12
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Rescue Dog Village Guardian, Inc.