Surrender Your Dog To Us

Interested in surrendering your dog to us?

Please fill in the application below and click “SUBMIT” and we will be in touch soon after to discuss the next steps.

Surrender Questionnaire

Completing this form does not guarantee Beulah Land Dog Rescue will be able to take and rehome your dog.

This form will allow Beulah Land Dog Rescue to assess your pet’s background, personality and needs.

A time will be scheduled for us to meet your pet should the review of this form determine that is necessary.

Please note, Beulah Land Dog Rescue will consider Owner Surrendered Dogs only from the Central Pennsylvania area.

  • General Dog Information:

  • Owners Personal Information

  • Background Information on Dog:

  • Medical History:

    Please describe any existing or resolved medical conditions. Please note if this Dog has been used for breeding purposes, had major surgery (other than sterilization), or been diagnosed with any hereditary diseases:

  • Veterinarian Information:

  • ** Please note a complete medical history needs to be given to Beulah Land Dog Rescue at the time of the Dog surrender **

  • Temperament:

  • Living Environment

  • Your Contact Information: