Request to Surrender Form


The Surrender process:

  1. Please fill out and submit the form below.

  2. Once your form has been processed, a member of our team will contact you to arrange to meet your dog.


Please Note: Filling out this form does not guarantee an evaluation appointment or that we will accept your dog.

By signing this form, I state I am the owner of the animal(s) who is/are the subject of this animal surrender form, hereinafter referred to as “the animal”. To my knowledge, no other person has any right to this animal. I hereby surrender all the rights to the animal to BARC-CT, (Bridgeport Animal Rescue Crew of Connecticut). I understand that once I relinquish the animal, the animal will not be available to be returned. I have read and understand the terms of this animal surrender form.

Name *
Address *
Cell Phone
Cell Phone
Home Phone
Home Phone
Are you able to provide vet records to support vetting history? *
Is your dog spayed/neutered?
Is your dog microchipped? *
Up to date on Rabies shot? *
Up to date on Distemper shot? *
Up to date on Bordetella shot? *
If yes, please describe in detail.
Does your dog have food or toy aggression? *
Does your dog have aggression towards other dogs? *
Does your dog have aggression towards cats or small animals? *
Is your dog good with children? *
Has your dog ever bitten another dog? *
Has your dog ever bitten a human? *
I understand that this form is NOT complete and can not be processed until I have emailed a minimum of one photo of the animal being surrendered. It "MUST" clearly show the dogs face and at least part of his/her body. Additionally, we encourage you to upload and email multiple photos as well as a short video clip, if possible. *