First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone*
Alt Email
Canine Name (if not unknown use description such as litter or mom) : *
Primary Breed:*
Secondary Breed:
Mixed Breed?* Choose one: yes no
Canine's Gender:* Choose one: female male
Canine(s) age:* Choose one: Baby Young Adult Senior
Type of dog(s) to be rehomed:* Choose one: single dog litter and mom litter (mom known) litter (both parents known) pair bonded dogs multiple not bonded dogs
Total number of dogs to be rehomed: * Choose one: none 1 2 3 4 5 6 7 8 9
Altered: Choose one: yes no
Where is the dog currently housed: * Choose one: inside my home outside in a fenced yard outside on a tether outside free roaming in boarding
I understand and agree that I will continue to care for the dog(s) until CCF has matched the dog(s) with an approved CCF adopter. (food and supplies can be provided upon request)* Choose one: I agree I disagree
I understand that CCF only accepts complete litters. I agree to not rehome any puppies or dogs to anyone not approved by CCF. * Choose one: I agree I disagree
I agree to have the mother and father dog (when available) spayed and neutered at the expensive of CCF.* Choose one: I agree I disagree
I agree to release all veterinarian records to CCF.* Choose one: I agree I disagree
I agree to follow all spay/neuter, vaccination, deworming, and preventative schedules provided by CCF. I will make all efforts to transport dog to veterinarian appointments or inform foster coordinator within 48 hours of appointment of unavailability. * Choose one: I agree I disagree
For adult dogs, surrendering owners must speak directly with approved adopter to ensure they are the perfect fit for their new family. I agree to speak with adoptive family and provide truthful and helpful feedback to both adopters and CCF adoption coordinators. * Choose one: I agree I disagree
Would you like to remain anonymous as the surrendering owner to new adopters?* Choose one: yes no
I understand that after acceptance to the "New Home for Rover" program that I will immediately be signing over ownership rights of the dog(s) to the Canine Compassion Fund. * Choose one: I agree I disagree
Additional Comments: