Yorkie Rescue Surrender Form Surrender Form If you need to rehome your Yorkie, please fill out the information below and one of our volunteers will contact you. Your Name(Required) First Last Your Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code How Can We Reach You?Let us know how to contact you about your surrenderYour Email Address(Required) Email Address Confirm Email Address Your Phone(Required)Preferred Method of ContactSelect Method HereEmailPhoneDog's Name(Required)Age(Required)Weight(Required)Please enter a number from 0 to 30.Sex of the dog(Required) Male Female Spayed or Neutered Status(Required) Yes No Up to date on vaccines?(Required) Yes No Which vaccines up to date on(Required) Rabies Distemper Bordatella Lyme Other Select AllOther Vaccines (list here)(Required)Up to date on heartworm?(Required) Yes No Reason for surrendering your dog(Required)Has your dog ever bitten a human?(Required) Yes No NameThis field is for validation purposes and should be left unchanged. Join Us TodayMake a Difference in a Yorkie’s LifeBecome a part of our community and help us save more Yorkies in need of loving homes.Adopt Now
