Surrender a Dog to MCR

Please complete the form below to be considered for our waiting list. MCR Staff will review your submission and contact you as soon as we can. Please be patient, as we have limited resources, and these inquiries typically take about 7 days to process.

Please note that medical records are required. You will be able to upload a file below. If you have any trouble doing so, please feel free to email and include the records as attachments.

    Your Full Name

    Your Phone Number

    Your Email

    Dog’s Name




    Intact FemaleSpayed FemaleIntact MaleNeutered Male


    How long has this dog been in your care?

    How did you acquire this dog?

    Friend or familyAdopted from shelter or rescuePrivate purchase from breeder or other (Craigslist, etc)

    If this dog was originally adopted from a shelter or rescue, please name the organization below.

    Please tell us why you wish to surrender this dog.

    Please provide a detailed history of your dog’s health.

    Please attach a copy of your dog’s medical records.

    How would you describe your dog’s energy level?


    Please select any/all characteristics that apply to your dog’s personality.


    If you selected any characteristic with an asterisk, please provide detailed information about your dog’s behaviors.

    What causes your dog to feel afraid and/or anxious? How does s/he react when experiencing fear or anxiety?

    How does your dog respond when humans/animals approach or take food, toys, treats, or other valued resources?

    How does your dog generally respond to strangers? Consider the following scenarios: knocking on the door, entering the home, approaching your dog while outside of the home.

    Has your dog ever lived in a home with children?

    YesNoI don't know

    If your dog has lived with kids before, please indicate their ages.

    Please describe your dog’s behaviors around known children.

    What about children s/he doesn’t know?

    Has your dog ever lived with cats?

    YesNoI don't know

    Has your dog ever lived with other dogs?

    YesNoI don't know

    How does your dog behave around cats that s/he knows?

    What about unfamiliar cats?

    How does your dog behave around dogs that s/he knows?

    What about unfamiliar dogs?

    Has your dog ever injured another animal?

    YesNoI don't know

    If you answered yes, please explain the incident(s) in detail.

    Has your dog ever acted in one or more of the following ways?


    If you checked any box, please explain any/all incidents in detail.

    Has your dog ever received professional training?

    YesNoI don't know

    If your dog has worked with a professional trainer, please describe that experience.

    Please identify any commands or cues your dog knows.

    SitStayDownComeHereHeelShakeOffLeave itKennelOKFetchPlay deadHand signals

    Does your dog exhibit any of the following behaviors?

    DiggingInappropriate chewingDestruction of home/propertyExcessive barking/howlingBolting/roamingChasing vehicles/bikes/scootersChasing peopleJumping fencesDisliking menDisliking womenNone of the above

    Where does your dog spend most of his/her time?


    How long is your dog left alone each day?

    Is your dog house-trained?


    If your dog crate-trained?


    What do you like most about your dog?

    What do you like least about your dog?

    The information provided in this form is true and complete to the best of my knowledge.