Surrender Application

Buffalo Pug & Small Breed Rescue, Inc. recognizes that, due to unforeseen and unfortunate circumstances, owners may be faced with the difficult decision of surrendering their dog to rescue. If you find yourself in such a predicament and have made all reasonable effort to rehome your dog, please fill out the following form. Please note, however, that completion of this form does not guarantee acceptance into our program. It may also take some time to find an available foster compatible with your dog's needs and personality.

By filling out this application:
  • I certify that the information I have provided is true and correct.
  • I certify that I am the legal owner of the dog described above.
  • I understand that submission of this form does not guarantee that my dog will be accepted into the program.

Please enter your application below.

Dog information
Dog name :
Breed1 :
Breed2 :
Color :
Age :
Sex :
Weight :
Altered :
Housebroken :
Good with cats :
Good with dogs :
Barker :
Good with children :
Digs :
Aggressive :
Disposition :
Health :
Shot record :
Reason for release :

Owner information
Owner name :
Email :
Address :
City :
State :
Zip :
Phone :
Other comments :

This form is generated by FormHandler