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Surrender Form

All items with an asterisk (*) are mandatory

Please be as honest and detailed as possible. The more we know about your pet, the better we are able to place him/her in the most suited foster home and rehome him/her to the best possible fur-ever home.

Contact Information:
Veterinarian Information:
Medical History:

It would be very helpful if any original veterinary history could be provided to the rescue upon surrender.

Please explain any applicable conditions or ailments your dog has currently or had in the past.

Are you aware of any other conditions, disease or illness your dog may currently have or has had in the past?

Does your dog require any medication for a temporary or ongoing problem?

Behaviour & Personality:

It is important to let us know any behaviour problems or concerns. We want your dachshund to go to a good, permanent and loving home. To accomplish this, we need to know as much about his/her good and not so good traits.

Does your dog like baths/showers, grooming, brushing coat, brushing teeth, nail trims, Dremel, being pet, being picked up, drives, walks, other dogs, cats, small animals, small/young children, older children, men, women

Where does your dog spend the day?

How many hours a day is your dog left alone?

To your knowledge, has your dog ever bitten anyone? If yes, please provide details of the incident.

Does your dog suffer from separation anxiety? If yes, how do they express their anxiety? 

Diet & Feeding Information:
Items accompanying your dachshund:

I/We are the owner(s) of this dachshund and hereby relinquish all present and future rights and claims to this dachshund and all items transferred with him/her to the Atlantic Canadian Dachshund Rescue. I/We certify that the information provided to ACDR is everything known about this dachshund to ensure the dachshund's continued happiness and welfare. I/We understand that I/We will not be provided the information of the dachshund's whereabouts in foster care or once adopted.
If completing this form online, by typing your name on the signature line, you are legally surrendering your dog into our care and accepting the terms set out in this release. 

Surrendering Owner Signature

Co-Owner's Signature

Print Name

Print Name

Date (D - M - Y)

Date (D - M - Y)

Atlantic Canadian Dachshund Rescue
Representative Signature

ACDR Representative Print Name

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