Pet Orphans of Southern California: Pet Relinquishment Dog Form

Pet Orphans of Southern California

A home for every pet starts with a place in the heart

Pet Relinquishment Dog Form

Please take a few minutes to fill out the form below. Please note that if you have not heard back from Alice, Kennel Manager, after one week, this means that Pet Orphans of Southern California is not able to take in your dog. For further assistance with placing your animal, please visit our Private Adoption Assistance Program page.

Please note all fields are required.

Firstname:		Lastname:
Home Number:		Work Number:
Cell Number:		Email Address:

What is the age of the dog?

What is the sex of the dog? Male Female

What is the weight of the dog?

What is the breed or breed mixes of the dog?

How did you acquire the dog?

How long has this dog been in your care?

Why do you need to relinquish the dog?

Have you seen the dog interact with dogs or cats? Yes No
If yes, what were the results?

Have you seen the dog interact with children? Yes No
If yes, what were the results?

Are there any current medical issues?

Are there any behavioral issues?

Thank you for taking the time to help an animal in need.