Information about you
State / Province / Region
Why are you needing to surrender your dog?
How soon do you need to surrender your dog?
Information about the pet being surrendered
Pet's Date of birth
Is your dog Spayed / Neutered?
If your dog has not been
spayed/neutered there will be a $150 surrender fee. If you can
not afford the surrender fee, please continue to ll out the
form and we will call you to discuss it.
What is the name of your vet?
Is your dog up to date on shots?
When did your dog last receive shots?
Does this dog have any medical problems that you are aware of?
List any medical issues you are aware of (e.g. stiffness, limping, sores, lumps, bumps)
Is your dog taking any medications? If yes, list all medications and reasons.
Please let us know the name of the shelter/breeder/rescue place of purchase where you obtained your dog.
How long have you had this dog?
Additional information about the pet you are surrendering
Does your dog get along with others?
Check all that apply - Do not check if you are not sure.
Does your dog currently live with other animals? If so, what animals?
Have you experienced destructive tendencies?
Chewing household objects, breaking fences, etc
Does your dog jump a fence?
If your yard is fenced, list material and type (e.g., 4-foot chain link, 6-foot privacy). If you do not have a fence, please list “no fence” or “no yard” as applicable.
Does this dog show interest in escaping the yard? If yes, please list exhibited behavior(s) (e.g., jumping, climbing, digging, sneaking through gate).
When you are home, is your dog?
When you are away from the house, this dog stays:
Is your dog house trained?
Brand name of the food you are feeding your dog?
How much is this dog eating at each feeding?
Does he/she show any food possessiveness toward people or other animals? If yes, please explain.
Is your dog crate trained?
How often do you walk your dog?
How is his behavior on leash?
Does your dog walk well on a leash?
Do you walk your dog with:
When confronting a stranger, this dog:
Describe this dog’s greeting manners with people:
Is afraid of what elements
Has your dog shown either fear or aggression? Please explain:
How is he/she with other dogs?
Please be as thorough as possible here!
Has your dog ever bitten a person or child? If so, please explain?
Has your dog ever bitten another animal? If so, please explain?
What commands does this dog know? (sit, down, stay, come, go to bed, off, others)
Does this dog do any of the these?
Please, send us images of your dog at
All Information above is true to my best knowledge.
I relinquish all rights of ownership of this animal to the Colorado Saint
Bernard Rescue. I understand that this is not a guarantee of
placement. I understand that is may take a few weeks for the Colorado
Saint Bernard Rescue to take my dog as Shelters dogs come first and
there is a waiting list.
Please type your name to varify the information about is true.
I understand that there is a surrender fee of $150 if my dog has not been fixed (can still breed).