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Homeward Bound Dog Rescue of New York
Owner Surrender Application

* = Required fields.
Phone numbers:*Email Address 
Is this a former HBDR dog?
If not from HBDR, where did you adopt or purchase the dog from
Reason for surrender:
Name of dog
Breed:Is the dog microchipped? 
Is the dog up to date on all vaccines, heart worm and Lyme testing?
Is the dog spayed/neutered?
Are you using flea/tick and heart worm preventative?
Brand and last time administered
What and how much are you feeding your dog?
Behavior Is the dog housebroken?:Crate trained? 
Where is the dog during the day/night?
Does the dog have behavior issues with men/women/children?
Does the dog have a bite history?
Please explain the circumstances:
Has the dog been socialized with other dogs?:Cats? 
Please give us a brief description of the dog’s personality
Please list commands the dog knows and any training it has had
I certify that my dog is not aggressive and it has never had a bite history. If my dog has had an aggression or bite history and I do not inform Homeward Bound Dog Rescue of New York, Ltd of this history and the dog is adopted and causes injury due to aggression or bite, I understand that I can be held personally responsible for any injuries incurred.
Upon receiving this form, a volunteer will contact you and give you details for the possible surrender and the evaluation times. Medical history from a vet will need to be emailed to us prior to the evaluation.
I certify that the information provided on this form is true and correct. I understand that an evaluation of the dog and a temperament test will be performed by an experienced rescue volunteer for the purpose of allowing Homeward Bound Dog Rescue of New York, Ltd to ensure that the dog is appropriate for re-homing before accepting the dog into its adoption program. I understand that if, during the evaluation process information presented by me on this surrender form is deemed to be false, then Homeward Bound Dog Rescue of New York, Ltd retains the right to decline the accept the dog I wish to surrender.
I understand that the following criteria must be met before Homeward Bound Dog Rescue of New York, Ltd will consider taking my dog as an owner/HBDR surrender.
Dog must be: 1. Current on all vaccinations. 2. Heart worm negative. 3. Spayed or neutered. 4. Owner must make a donation of at least $200 to Homeward Bound Dog Rescue of New York, Ltd in order for the dog to be accepted. If this is an HBDR dog, the suggested donation is $100 to help provide food and medical care.
Do not sign or date this form until the dog is accepted into the program.
Dated: Donation received by: 
Dated: Owner's signature: 
Dated: Owner's signature: 
Homeward Bound Dog Rescue of New York, LLC.
P.O. Box 5782
Albany, NY 12205

Adoption Clinics:
Saturdays, 10:00-1:00

202 Front St.

(our entrance is really on John St.)
Schenectady, NY 12105

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