Owner Surrender Form

    For a dog to be surrendered to NBCR, we ask for the owner's help by providing the following information.

    We request as much information as possible from the owner so that we are able to place a dog in an appropriate foster home.  Please provide detailed in responses.

    Contact Information
    Name:

    Phone Number:

    Email Address:

    Address:

    City, State:

    Zip:

    What is the name and contact information for your current veterinarian? Please provide or attach veterinary records.

    Attach records here:

    Dog's name:

    Dog's age:

    Dog's gender:

    Is your dog intact or altered (spayed/neutered)?
    IntactSpayedNeutered

    Why are you seeking to surrender your dog?

    How does your dog interact with other dogs?

    How does your dog interact with people?

    Where does your dog spend the majority of their time? Are they indoors? Outdoors? Kenneled?

    Anything else you would like us to know about your dog...