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

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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:

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Dog's Height (at shoulders)

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Other Dog Information

Location of rescue dog (City/State)

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Good with cats?

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Good with dogs?

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Good with children under 12?

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Good with children over 12?

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Does this dog have special needs?

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Describe such things as medical conditions, required medication etc...

Reason for request

Explain the circumstances prompting you to request assistance for the dog, or why you desire to surrender this dog to HRI.

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You can attach a photo of your dog here. LIMIT THE SIZE OF YOUR FILE TO 5 MB. If your file size is too large your form won't go through. If you want to provide more than one photo, or you can't reduce the size of the one you have, please email them HERE. Use the dog's name as the subject of the email!

Attach a photo of the dog

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Dog Assistance Request