Please fill out this form as completely as possible. Press submit when finished to send it electronically.
For a PDF version of this form that you can print and fill out and mail to the address shown on the form, click here.

Should we take your dog, we will need:
  • A complete copy of the vet records;
  • A rabies certificate dated within the last two and one half years;
  • If the dog is not current on vaccines within the last three years, then this will need to be done prior to our taking possession;
  • If the dog is not spayed/neutered this will also be mandatory before we take possession or list the dog;
  • We ask a $50.00 donation to list your dog on our website and $100 donation to actually take your dog. These donations are both tax deductible.
If we take your dog, we request a large bag of Avoderm Chicken & Rice dog food, dog toys, collar, leash, crate if he/she uses it, and dog bowls. This helps us help your dog.

As a reminder, we are not always able to take your dog from an area shelter so it is best to work with us directly. Dying in a shelter (very great possibility if the dog is not under 5 yrs of age, able to pass a very stringent evaluation, is not fat, and is very healthy) is a horrible way to end a life....scared, abandoned and alone. Pleae speak with us before you take your dog to a shelter. We will help if we can.

We generally cannot take owner surrenders, but if we have a foster home we will consider taking your dog.


Dalmatian Rescue of Colorado, Inc.
6828 Rim Rock Trail
Fort Collins, CO 80526
melodee101@msn.com

Full Name:
Street Address:
City: State:   Zip:  
Phone:       Home:    Work:    Cell:
Email:        Home:   Work:
   
Dog Name:
Dog Sex Male Female
Dog Age:
Is Dog Altered?:  Yes  No

Reason for surrender:

Veterinarian Name:
Address:
Phone: 

When were last vaccinations given? 

Is the dog on heartworm preventative? Yes  No  
 
Microchip number and company (if available): 


What brand of dog food was fed and how often per day?
   
 Describe the dog's health status


Is your dog housebroken? Yes  No  

Does your Dog live indoors or outdoors?  Indoors Outdoors

How long is the dog left inside at any one time?

When indoors, describe it's living situation:

Describe the temperament of your dog in the home:

Are there any bad habits?

How does the dog treat strangers at your door? Excellent  Good  Fair  Poor

How is your Dal with children/kids (what ages)?  (fearful, aggressive?)

What is the age of the youngest child your dog has been with?

Has this dog ever bitten a human? If so, when, how badly and what were
the circumstances? Was law enforcement or animal control involved?

Does your dog live with other pets now? Yes  No
   
How is your dog with other pets, including dogs, cats, birds, caged animals, etc?
  
Has this dog ever injured another animal, dog, cat, other? Describe the
circumstances. Was law enforcement or animal control involved?

How does your dog walk on the leash?  Good  Fair  Poor
   
How does it act in the car? Good  Fair  Poor
   
Has the dog had any formal obedience training ?  Yes  No
   
Height of fence dog has been contained in:  Type of fence:
   
Has your dog jumped fences or escaped from doors or gates? Yes No
If yes, explain: 

Have you tried placing an ad in the newspaper or tried a friend, family member or signs posted at work to take your dog? Yes No
  
To place your dog on our web site please have the following info:

1.  Several appealing or pleasant digital photos. Show the dog's good side and make him/her desirable.
2.  Full written description of your dog's good points, faults, habits and needs, and the type of home you'd like it to have. 

The  more information we have increases the chance of getting your dog a forever home.

Should we have a foster home available for your dog, we will need a large bag of Avoderm Chicken & Rice dog food, the dog's leash, collar and food/water bowls, as well as bed and toys to help with the dog's transition.

I wish to List with  Surrender my Dalmatian, described and named above, to Dalmatian Rescue of Colorado, Inc. and verify that the information given is true and correct for this Dalmatian.

Date:

Initials: (Use of your initials constitutes electronic signature)