Surrender Form

Due to an increase in the volume of requests we receive for assistance, we require the following information from anyone interested in surrendering a dog to HRI or asking for help for a Havanese in need.

Please provide as much information as possible. Responses to submissions with missing/incomplete information may be delayed. Thank you!

Submisssion of this form is not a commitment to surrender your dog. It is simply a request for assistance. When we contact you, we will discuss all possible solutions to your situation.

PLEASE DO NOT USE THIS FORM TO INQUIRE ABOUT YOUR ADOPTION APPLICATION! FOR THESE INQUIRES PLEASE CLICK HERE

Requester Information

Your Name(*)

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Your Email(*)

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Phone Number(*)

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Best Time To Call(*)

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How did you find us?(*)

Internet SearchSocial MediaRecommendedOther

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If you answered "Other" above please explain

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Where did you get your dog? (e.g., stray, shelter, friend, breeder)(*)

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If you got your dog from a breeder what was the Kennel Name/Breeder Name

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Breeder Email Address (if known)

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Breeder Phone Number (if known)

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Dog Description

Dog's Weight(*)

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Dog's Name(*)

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Dog's Age(*)

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Is your dog:(*)

SpayedNeuteredIntact

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Dog Location

City Dog is Located(*)

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State Dog Is Located In(*)

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Dog Behavior

I certify the dog has never bitten a human or another dog and drawn blood.

Please make selection below.(*)

CertifyCan Not Certify

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Good with cats?(*)

YesNoNot sure

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