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(*)

Invalid Input

Your Email(*)

Invalid Input

Phone Number(*)

Invalid Input

Best Time To Call

Invalid Input

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

Invalid Input

Dog Description

Dog's Weight

Invalid Input

Dog's Name

Invalid Input

Dog's Age(*)

Invalid Input

Is your dog:

SpayedNeuteredIntact Invalid Input

Dog's Height (at shoulders)

Invalid Input

Other Dog Information

Location of rescue dog (City/State)

Invalid Input

Good with cats?

YesNoNot sure Invalid Input

Good with dogs?

YesNoNot Sure Invalid Input

Good with children under 12?

YesNoNot sure Invalid Input

Good with children over 12?

YesNoNot sure Invalid Input

Does this dog have special needs?

Invalid Input

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.

Invalid Input

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

Invalid Input

Dog Assistance Request