EmailMe Form - Surrender Application

Please Read Carefully.

Please use this form for any dog that you are requesting to surrender to Yorkie Rescue of America.

Surrendering your dog is an irrevocable decision; once surrendered, you release your rights as a pet owner. Yorkie Rescue of America does not return or readopt dogs to the surrendering owner.

If you are not the owner, do you have the authority to surrender this dog?

A representative from Yorkie Rescue of America will be in contact with you as soon as possible to discuss your Yorkie and will determine if we have an appropriate home to accommodate your dog's needs.

This form must be completed in its entirety before we can consider accepting your dog into Yorkie Rescue of America.

Do you agree? Yes/No.

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Number *

### - ### - ####

Secondary Contact Number *

### - ### - ####

Email Address *

Re-type your email address *

Your Pets Information

What is your pets name?

Sex *

MALE

FEMALE

Please Specify Your Dogs Age, Breed, Date of Birth and Weight

Is Your Pets Vaccinations Up To Date? *

Yes

No

Please Specify All Shots Given and Administer Dates. Please Specify any tests such as Heartworm and fecal and the dates they were performed. Please also list any medications your pet is currently given.

Is your pet friendly with children? *

Yes

No

Is your pet spay or neutered? *

Yes

No

Is your pet microchipped? *

Yes

No

Please provide treating Veterinarian information.

Are you the original owner? *

Yes

No

If we cannot help you with your surrender, would you like YROA to refer you to another rescue? *

Yes

No

Yorkie Rescue of America may ask for a donation for your Yorkie which will go towards any incomplete medical needs that need to be performed in order for us to be able to adopt your Yorkie into a home. Will you provide a donation? *

Yes

No

Is your pet trained? House, crate, obedience? Please specify.

Is your pet friendly with other dogs, cats and people in general? Please specify.

Can you provide a summary/bio of your pet? *

Surrendering your dog is an irrevocable decision; once surrendered, you release your rights as a pet owner. Yorkie Rescue of America will not readopt the surrendered Yorkie to surrendering owner. By selecting "I agree", you understand and agree to this term. *

I agree

I don't agree

Do you agree with the terms and conditions? *

Yes, I agree.