ECCR Surrender Intake

Questions marked with a * are required

Thank you for requesting assistance from ECCR in surrendering your dog.

Please note that only the owner/co-owners (or whoever currently has primary responsibility for the dog) will be allowed to surrender to ECCR. We receive many surrender requests per week which leaves us with little time to pursue "leads". We will not contact someone about surrendering a dog who has not contacted us first.

Please do not use this form to submit any "found" dogs or dogs that are being held being held by a shelter or rescue unless you are an employee or authorized volunteer with that shelter or rescue. If you have found a lost dog, please contact your local animal control agency.

If you are seeking to surrender more than one dog, please fill out a surrender request for each dog.

The more information you can provide about the dog, the more quickly we will be able to rescue them, so please provide as much information as you may know.

Please provide your contact information.

First Name

Last Name

Mobile Phone

Email Address

What is the dog's name?

Where is the dog currently located?

With me

At a shelter/rescue

With someone I know

Other

And in what city and state?

	City	Column 2


Please enter city and choose a state

How soon does this dog need to be rescued?

Are you willing to help transport the dog to a nearby foster, or as part of the first leg of a foster transport?

Yes

What is the breed of the dog?

Pembroke Welsh Corgi

Cardigan Welsh Corgi

Corgi Mix

Other Breed

What sex is the dog?

Female

Male

Has the dog been spayed or neutered?

Yes

Don't Know

What is the approximate age of the dog? (If you aren't sure, please provide your best guess.)

Has the dog ever scratched or bitten anyone, for any reason?

Yes

Don't Know

East Coast Corgi Rescue is a 100% volunteer foster-based rescue. While our fosters are experienced dog owners, they are not certified trainers. We are not a rehabilitation rescue and do not have many resources to take in dogs with a history of extensive aggression.

If your dog has aggression with a history of biting, you will need to seek help from skilled professional trainers or veterinarians who have experience in correcting behaviors with positive reinforcement. We recommend conducting an online search for someone in your area who can provide you with more assistance.

Was the bite or scratch reported to animal control?

Yes

Don't Know

Please provide more details on the bite history of the dog, including, who, what, where, and why (what triggered the bite) and if the bite broke skin.

Does the dog have any of the following behaviors? (This helps us select the best foster home)

Not dog friendly

Not cat friendly

Not good with children under 5

Food guarding

Resource guarding

Leash aggression

Not housebroken (unless due to medical reasons)

Excessive barking

Inappropriate chewing

None

Please provide more details about the behavioral issues you selected.

Does the dog have any medical conditions or special needs such as a past/current injury, illness or a special diet?

Yes

Don't Know

Please provide more details on any medical conditions we should know about and if/how they were treated, as well as if it is an ongoing issue a foster/adopter needs to be aware of.

Please answer these additional questions regarding the dog.

	Yes	No	Don't Know
Is the dog up to date on all required shots and vetting?	Yes	No	Don't Know

Is the dog potty-trained?	Yes	No	Don't Know

Is the dog friendly with other dogs?	Yes	No	Don't Know

Has the dog lived with cats?	Yes	No	Don't Know

Do you recommend the dog lives with other dog(s)?	Yes	No	Don't Know

Is the dog crate-trained?	Yes	No	Don't Know

Can the dog be trusted when left alone in the house?	Yes	No	Don't Know

Does the dog know any commands?	Yes	No	Don't Know

How long can the dog be left alone (either in a crate, or on his/her own)?

Is the dog dominant or submissive?

Dominant

Submissive

How would you describe the dog's energy level?

Couch potatoModerately energetic
Extremely energeticDon't Know

Energy Level

Moderately energetic

Why are you surrendering this dog?

Please provide any other information you would like us to know.