Dog Surrender Form – Nevada Society for the Prevention of Cruelty to Animals

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Please let us know about your dog. The information will help us in finding a good new home for your pet.

Dog Information for Surrender

Please complete all questions
Not completing required questions may result in a form error and it may not send your application.
The dog's name is*
Where did you get the dog?*
How long have you had the dog?*
Reason you are giving the dog up*
How old is the dog?*
What breed is your dog?*
Gender*
- Male
- Female
Is the dog spayed or neutered?*
Where does the dog stay during the day?
- In
- Out
- Both
If he sleeps inside, where does he sleep?
- Dog Bed
- Furniture
- Your Bed
- Other
Where?
How is the dog confined?
- 4' fence
- 5' fence
- 6' fence
- Chain
- Cable
- Kennel
- Invisible fence
- Only goes out on leash
Is the dog house-trained?
- Yes
- No
If house-trained, how often does the dog need to go out?
If your dog has accidents, is it only when left alone?
- Yes
- No
Medical Information
Does your dog have a microchip?
- Yes
- No
Your dog's vet clinic information:*
Please provide: Name of the clinic, address and phone number.
Is your dog on medication or have any medical conditions?*
Is your dog current on vaccinations?*
It is required that you bring in your dog's current records during surrender.
Does your pet have any of the following conditions?*
- Allergies
- Prescription Dietary Needs
- Diabetes
- Heart Murmur
- Heart Disease
- Arthritis
- Dental Issues
- Heartworms
- Parvo
- Kidney Disease
- Cancer
- None of the above
Personality Questionnaire
Please give details on your pet's personality so staff can understand the best fit for their new home.
Check all that apply to describe your dog's personality:
- Select All
- Friendly
- Independent
- Shy
- Active/Hyper
- Quiet
- Protective
- Nervous
- Calm
- Submissive
- Dominant
- Loves to play
- Loves toys
- Affectionate
- Couch potato
What is your dog afraid of?
Where is your dog sensitive about being handled? (example: ears, feet, etc.)
Does your dog destroy things in the house or yard?
- Yes
- No
What items?
How often?
Has your dog ever lived with children?
- Yes
- No
If he has ever lived with children, what ages?
Is your dog good with those children (friendly, tolerant)?
- Yes
- No
If he is not good with children, please explain.
If your dog doesn't live with children, how often does he/she interact with children?
What does your dog do if:
a child touches or pets him/her?
Has your dog ever growled at you or anyone else?*
If your dog has ever growled at you or anyone else, please explain the situation.*
Has your dog ever snapped at you or anyone else?
If your dog has ever snapped at you or anyone else, please explain the situation.*
Has your dog ever bitten (broken skin) you or anyone else?*
If your dog has ever bitten (broken skin) you or anyone else, please explain the situation.*
What other animals has your dog lived with?
- Dogs
- Cats
- Other
Please specify.
If applicable, does he/she do well with the house cat/s? Any issues?
If applicable, does he/she do well with the other dog/s? Any issues?
How does your dog react when he/she sees an outdoor cat?
How does your dog react when he/she sees a small animal like a squirrel?
How does your dog react when he/she sees another dog outside?
Is his/her behavior different when on compared to when off leash when seeing another dog?
How does your dog act at the dog park?
Has your dog ever fought with another dog?
- Yes
- No
Has your dog ever injured another dog?
- Yes
- No
Does your dog: (please mark all that apply)
- Run away
- Bark too much
- Jump up on people
- Dig in the yard
- Other
Please specify
What does your dog do when:
A stranger/visitor knocks on the door?
A stranger/visitor comes into the house?
A stranger approaches you on a walk?
You or someone else goes near the food bowl when he/she is eating?
You or someone else tries to take away toys or a dog treat?
You or someone else gives him/her a hug?
You or someone else reprimands him/her?
Have you or has someone else trained him/her?
- Yes
- No
Have you or has someone else ever taken your dog to a training class?
- Yes
- No
What kind of training have you tried?
- Choke chain
- Electric shock
- Treats
- Praise
- Clicker
What commands does he/she know?
- Sit
- Down
- Stay
- Come
- Shake
- Roll over
- Other
What is your dog's favorite game or toy?
What is your dog's best quality?
What is your dog's worst quality?
Is there anything else we should know about this dog?
By checking this box you are adding your signature to this document, and are agreeing that all of the above information is correct to the best of your knowledge.*
- I agree
Pet Photo
Upload A Pet Photo
Max. file size: 50 MB.
Please upload a current photo of your pet. This helps staff determine size on mixed breed pets to allow for proper kennel space.
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Enter Email Confirm Email
Phone*
Please allow 48-72 hours for review. Owner surrenders take place Monday through Friday.*
- I agree
Nevada SPCA is run by donations and does not receive any government funding. To help ensure continued care for rescue animals there is a $25 surrender fee per pet.*
- I agree

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Nevada Society for the Prevention of Cruelty to Animals is a 501 (c)(3) charitable non-profit organization.

EIN: 88-0187383.

Email Address info@nevadaspca.org

Phone Number (702) 873.7722

Location 5375 Procyon Street, Suite 108, Las Vegas, NV 89118

Hours: Monday - Saturday: 10:00am-4:00pm | Closed: Sundays