Name *

First Name

Last Name

Phone *

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Full Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your animal being returned after previously being adopted from Coco's Heart Dog Rescue? If so, we will respond to the surrender request automatically. *

As a reminder, all animals adopted from CHDR need to be surrendered back to our organization and follow our standard surrender process. This is outlined in our adoption agreement.

Yes

No

Is your animal spayed or neutered? *

Yes

No

Would you be interested in a behaviorist recommendation? *

Often times behaviorists can help make a huge difference in helping owners better communication and succeed together.

Yes

No

Does your animal have experience around cats? *

Yes

No

Does your animal have experience on a leash? *

Yes

No

Is your animal housebroken or litter-trained? *

Yes

No

Are you available to drive your animal to Somerset, WI for the surrender? *

We are not available on weekends.

Yes

No

Are you interested in fostering your animal until an adopter is found? *

We cannot guarantee how long it will take to find a match.

Yes

No

I understand this inquiry is not releasing ownership of my animal to CHDR. If the surrender take places, I understand I will need to print, sign, and bring with a surrender form sent by CHDR. This form will legally release my ownership rights over to CHDR. *

This surrender inquiry is the first step. This is not considered a legal release form. CHDR will send the form when contacted.

Yes- I understand I will need to print, sign, and bring with the form sent by CHDR.

No- I will not sign a surrender form, releasing my ownership rights to CHDR.