Staff Entrance

Please complete the form below. Answer all questions honestly and to the best of your knowledge. Someone will be in touch with you within 24 hours of receiving this information. You will also be sent a copy of this form for your own reference. You must enter an email address for this form to be properly submitted.

Please note that we can only assist with dogs that are currently located in North Carolina. If you are in another state, please visit our links page for more groups.

Your name:
Your e-mail address:
Location of Dog:
Your phone number:
Dog's name:
Dog's age:
Dog's color:	Sable/White Tricolor Blue Merle Bi Blue Bi Black Sable Merle Mahogany Sable Double Merle
Dog's gender:	Male   Female
Up to date on shots?	Yes   No
Spayed or neutered?	Yes   No
Has the dog ever bitten a person or another dog, resulting in broken skin or other bodily harm?	Yes   No
Why are your surrendering the dog?
Describe any health problems:
What is your timeframe for surrendering the dog?
Comments or questions:
Enter the text from the image above: