Kenton County, KY

Step One

Name*
Email Address*
Address*
City*
State*
Zip Code*
Phone Number*
Alt. Phone Number
Animal ID
Has your dog bitten in the last ten days?*
1. Yes
2. No
General Information:
Shelter Arrival Date
Shelter Arrival Date
Dog's Name
Dog's Age
(or approximate)
Dog's Sex
1. Male
2. Female
3. Unsure
Is dog spayed/neutered?
1. Yes
2. No
3. Unsure
What kind of ID does your dog have?
1. Tattoo
2. Microchip
3. None/Other/Unknown
Where is the tattoo located?
Why are you surrendering your dog?
If surrender reason is behavioral, please explain.
If we could help you resolve this issue would you be interested in keeping the dog?
1. Yes
2. No
Have you tried to find a home for this dog on your own?
1. Yes
2. No
If so, how did you go about this?
How long have you owned your dog?
Including yours, how many homes has this dog had?
Have you contacted any breed-specific rescue groups for help in re-homing your dog?
1. Yes
2. No
Where did you acquire this dog?*
1. KCAS
2. Another shelter
3. Rescue organization
4. Breeder
5. Born in my home
1. Newspaper Ad
2. Friend/Relative
3. Pet Store
4. Other
Other:
*If your pet was adopted from another shelter or rescue organization, please contact them prior to scheduling an appointment with us to verify their return policy.
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Are there any additional comments you would like to add about the dog that would be helpful to families considering adopting him or her?

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