Pet Surrender Date Last Name First Name Address City State Zip Code Phone Number Email Animal Name Species DogCat Cat or Dog Breed (select one) AbyssinianAegean catAffenpinscherAfghan HoundAfricanisAidiAiredale TerrierAkbash DogAkita InuAlangu MastiffAlano EspañolAlapaha Blue Blood BulldogAlaskan Klee KaiAlaskan MalamuteAlauntAlopekisAlpine DachsbrackeAlsatian ShepaluteAmerican AkitaAmerican BobtailAmerican BulldogAmerican Cocker SpanielAmerican CurlAmerican Eskimo DogAmerican FoxhoundAmerican Hairless TerrierAmerican LonghairAmerican MastiffAmerican Pit Bull TerrierAmerican PolydactylAmerican ShorthairAmerican Staffordshire TerrierAmerican Water SpanielAmerican WirehairAnatolian Shepherd DogAnglo-Français de Petite VénerieAppenzeller SennenhundArgentine DogoAriegeoisAriege PointerArmantArtois HoundAsian Semi-longhairAustralian BulldogAustralian Cattle DogAustralian KelpieAustralian MistAustralian ShepherdAustralian Silky TerrierAustralian Stumpy Tail Cattle DogAustralian TerrierAustrian Black and Tan HoundAustrian PinscherAzawakhBakharwal DogBalineseBarbetBasenjiBasque Shepherd DogBasset Artésien NormandBasset Bleu de GascogneBasset Fauve de BretagneBavarian Mountain HoundBeagleBeagle-HarrierBearded CollieBeauceronBedlington TerrierBelgian Shepherd (Tervuren)Belgian Shepherd DogBelgian Shepherd Dog (Groenendael)Belgian Shepherd Dog (Laekenois)Belgian Shepherd Dog (Malinois)BengalBergamasco ShepherdBerger Blanc SuisseBerger PicardBerner LaufhundBernese Mountain DogBichon FriséBillyBirmanBisbenBlack and Tan CoonhoundBlack and Tan Virginia FoxhoundBlackmouth CurBlack Norwegian ElkhoundBlack Russian TerrierBloodhoundBlue LacyBlue Paul TerrierBluetick CoonhoundBoerboelBohemian ShepherdBologneseBombayBorder CollieBorder TerrierBorzoiBosnian Coarse-haired HoundBoston TerrierBouvier des ArdennesBouvier des FlandresBoxerBoykin SpanielBracco ItalianoBraque d'AuvergneBraque du BourbonnaisBraque du PuyBraque FrancaisBraque Saint-GermainBrazilian ShorthairBrazilian TerrierBriardBriquet Griffon VendéenBritish LonghairBritish ShorthairBrittanyBroholmerBruno Jura HoundBucovina Shepherd DogBull and TerrierBullenbeisserBullmastiffBull TerrierBull Terrier (Miniature)Bully KuttaBurmeseBurmillaCairn TerrierCalifornia Spangled CatCanaan DogCanadian Eskimo DogCanadian PointerCane CorsoCardigan Welsh CorgiCarolina DogCarpathian Shepherd DogCatahoula CurCatalan SheepdogCaucasian Shepherd DogCavalier King Charles SpanielCentral Asian Shepherd DogCesky FousekCesky TerrierChantilly/TiffanyChartreuxChausieCheetohChesapeake Bay RetrieverChien-grisChien Français Blanc et NoirChien Français Blanc et OrangeChien Français TricoloreChihuahuaChilean Fox TerrierChinese Chongqing DogChinese Crested DogChinese Imperial DogChinookChippiparaiChow ChowCierny SeryCimarrón UruguayoCirneco dell'EtnaClumber SpanielColorpoint ShorthairCombaiCordoba Fighting DogCornish RexCoton de TulearCretan HoundCroatian SheepdogCumberland SheepdogCurly Coated RetrieverCymricCzechoslovakian WolfdogCão da Serra de AiresCão de Castro LaboreiroCão Fila de São MiguelDachshundDalmatianDandie Dinmont TerrierDanish Swedish FarmdogDevon RexDingoDoberman PinscherDogo CubanoDogo GuatemaltecoDogo SardescoDogue de BordeauxDonskoy or Don SphynxDragon LiDrentse PatrijshondDreverDunkerDutch Shepherd DogDutch SmoushondEast-European ShepherdEast Siberian LaikaEgyptian MauEloEnglish Cocker SpanielEnglish CoonhoundEnglish FoxhoundEnglish MastiffEnglish PointerEnglish SetterEnglish ShepherdEnglish Springer SpanielEnglish Toy Terrier (Black & Tan)English Water SpanielEnglish White TerrierEntlebucher Mountain DogEstonian HoundEstrela Mountain DogEurasierEuropean ShorthairExotic ShorthairField SpanielFila BrasileiroFindo[9]Finnish HoundFinnish LapphundFinnish SpitzFlat-Coated RetrieverFormosan Mountain DogFox Terrier (Smooth)French BrittanyFrench BulldogFrench SpanielGalgo EspañolGerman Longhaired PointerGerman PinscherGerman RexGerman Shepherd DogGerman Shorthaired PointerGerman SpanielGerman SpitzGerman Wirehaired PointerGiant SchnauzerGiant SchnauzerGlen of Imaal TerrierGolden RetrieverGordon SetterGrand Anglo-Français Blanc et NoirGrand Anglo-Français Blanc et OrangeGrand Anglo-Français TricoloreGrand Basset Griffon VendéenGrand Bleu de GascogneGrand Griffon VendéenGran Mastín de BorínquenGreat DaneGreater Swiss Mountain DogGreat PyreneesGreenland DogGreyhoundGriffon Bleu de GascogneGriffon BruxelloisGriffon Fauve de BretagneGriffon NivernaisGull DongGull TerrHamiltonstövareHanover HoundHare Indian DogHarrierHavana BrownHavaneseHawaiian Poi DogHimalayan/Colorpoint PersianHimalayan SheepdogHokkaidoHortaya BorzayaHovawartHungarian HoundHygenhundIbizan HoundIcelandic SheepdogIndian SpitzIrish Bull TerrierIrish Red and White SetterIrish SetterIrish Staffordshire Bull TerrierIrish TerrierIrish Water SpanielIrish WolfhoundIstrian Coarse-haired HoundIstrian Shorthaired HoundItalian GreyhoundJack Russell TerrierJagdterrierJapanese BobtailJapanese ChinJapanese SpitzJapanese TerrierJavaneseJonangiJämthundKaikadiKai KenKangal DogKanniKarakachan DogKarelian Bear DogKarst ShepherdKeeshondKerry BeagleKerry Blue TerrierKing Charles SpanielKing ShepherdKintamaniKishuKomondorKooikerhondjeKoolieKoratKorean Jindo DogKorean MastiffKromfohrländerKunming Wolf-dogKuriKurilian BobtailKuvaszKyi-LeoLabrador HuskyLabrador RetrieverLagotto RomagnoloLakeland TerrierLancashire HeelerLandseerLaPermLapponian HerderLarge MünsterländerLeonbergerLhasa ApsoLithuanian HoundLonghaired WhippetLottatore BrindisinoLöwchenMagyar AgárMaine CoonMajestic Tree HoundMalteseManchester TerrierManxMaremma SheepdogMcNabMexican Hairless DogMiniature Australian ShepherdMiniature Fox TerrierMiniature PinscherMiniature SchnauzerMiniature SchnauzerMiniature Siberian HuskyMioriticMolossusMontenegrin Mountain HoundMoscow WatchdogMoscow Water DogMountain CurMountain View CurMucuchiesMudhol HoundMudiMunchkinMurray River Curly Coated RetrieverNeapolitan MastiffNebelungNewfoundlandNew Guinea Singing DogNew Zealand HuntawayNorfolk SpanielNorfolk TerrierNorrbottenspetsNorth Country BeagleNorthern Inuit DogNorwegian BuhundNorwegian ElkhoundNorwegian Forest CatNorwegian LundehundNorwich TerrierNova Scotia Duck-Tolling RetrieverOcicatOjos AzulesOld Croatian SighthoundOld Danish PointerOlde English BulldoggeOld English BulldogOld English SheepdogOld English TerrierOld German Shepherd DogOregon RexOriental BicolourOriental LonghairOriental ShorthairOtterhoundPachon NavarroPaisley TerrierPapillonParson Russell TerrierPatterdale TerrierPekingesePembroke Welsh CorgiPerro de Presa CanarioPerro de Presa MallorquinPersianPeruvian Hairless DogPeterbaldPetit Basset Griffon VendéenPetit Bleu de GascognePhalènePharaoh HoundPicardy SpanielPixie-bobPlott HoundPodenco CanarioPointerPolish GreyhoundPolish HoundPolish Hunting DogPolish Lowland SheepdogPolish Tatra SheepdogPomeranianPont-Audemer SpanielPoodlePorcelainePortuguese PodengoPortuguese PointerPortuguese Water DogPražský KrysaríkPudelpointerPugPuliPumiPungsan DogPyrenean MastiffPyrenean ShepherdRafeiro do AlentejoRagamuffinRagdollRajapalayamRampur GreyhoundRastreador BrasileiroRatonero Bodeguero AndaluzRat TerrierRedbone CoonhoundRhodesian RidgebackRottweilerRough CollieRussell TerrierRussian BlueRussian SpanielRussian White, Black and TabbyRusskiy ToyRusso-European LaikaSaarlooswolfhondSabueso EspañolSage Ashayeri[10]Sage Mazandarani[11]Sakhalin HuskySalukiSamoyedSapsaliSavannahSchapendoesSchillerstövareSchipperkeSchweizerischer NiederlaufhundSchweizer LaufhundScotch CollieScottish DeerhoundScottish FoldScottish TerrierSealyham TerrierSegugio ItalianoSelkirk RexSeppala Siberian SleddogSerbian HoundSerbian Tricolour HoundSerengeti catShar PeiShetland SheepdogShiba InuShih TzuShikokuShiloh Shepherd DogShirak[12]SiameseSiberianSiberian HuskySilken WindhoundSingapuraSinhala HoundSkye TerrierSloughiSlovak CuvacSlovakian Rough-haired PointerSlovenský KopovSmall Greek Domestic DogSmall MünsterländerSmooth CollieSmålandsstövareSnowshoeSoft-Coated Wheaten TerrierSokokeSomaliSouthern HoundSouth Russian OvcharkaSpanish MastiffSpanish Water DogSphynxSpinone ItalianoSporting Lucas TerrierSt. BernardSt. John's Water DogStabyhounStaffordshire Bull TerrierStandard SchnauzerStephens CurStyrian Coarse-haired HoundSumxuSussex SpanielSwedish BeagleSwedish LapphundSwedish VallhundTahltan Bear DogTaiganTamaskan DogTeddy Roosevelt TerrierTelomianTenterfield TerrierThai/Old-style SiameseThai Bangkaew DogThai RidgebackTibetan MastiffTibetan SpanielTibetan TerrierTonkineseTornjakTosaToy BulldogToy Fox TerrierToygerToy Manchester TerrierTreeing CurTreeing Walker CoonhoundTurkish AngoraTurkish VanTurkish VankedisiTwisty Cat/SquittenTyrolean HoundUkrainian LevkoyUssuriUtonaganVizslaVolpino ItalianoWeimaranerWelsh SheepdogWelsh Springer SpanielWelsh TerrierWest Highland White TerrierWestphalian DachsbrackeWest Siberian LaikaWetterhounWhippetWhite English BulldogWhite Shepherd DogWire Fox TerrierWirehaired Pointing GriffonWirehaired VizslaYork Chocolate CatYorkshire TerrierÉpagneul Bleu de PicardieŠarplaninacOther Sex MaleFemale Age Has the animal lived with children? YesNoUnknown If so, please specify age and sex Has the animal lived with other cats and dogs? Yes NoUnknown If so, please specify the species Has the animal lived with animals other than cats and dogs? YesNo If so, please specify the species Has the animal been spayed/neutered? YesNo Unknown Is the animal up to date with its annual vaccinations? YesNoUnknown How long have you owned the animal? Why are you looking to rehome your animal? What is your timeframe for rehoming your animal? Where did you get the animal initially? Please read and check each box I understand that submitting this form does not mean that SEVHS can take my pet(s). I understand that SEVHS accepts pets into their Adoption program based on many factors. I understand that SEVHS will temperament test my pet(s) to determine eligibility. Submit
