If you need to surrender a yorkie or yorkie mix, please fill out the below information. If you do not know, please approximate to the best of your knowledge. Please be honest! Our mission states that we take in any dog, regardless of age, size or health condition. This information will allow us to place your dog in the best foster home possible. Someone in your area will get back with you as soon as possible to answer any questions you may have about the process and make arrangements. We understand this is a hard decision to make and try to make it as easy as possible on all parties.

All fields are required. Please mark with an n/a if the field is not applicable.

If you do not fill out ALL the fields, your form entry will be ignored.

First Name:

Last Name:

Address:

City:

State:

Zip:

Email:

Home Phone:

Alternate Phone:

Dog's Name:

Dog's Age:

Dog's Gender:

Dog's Weight:

Is dog spayed/neutered?:

Is dog up to date on vaccination?:

If no, please explain:

How did you hear about UYR?:

Please list any medical issues that your dog has:

Please list the name and phone number of a veterinarian where we can obtain medical records for your dog:

I will contact my veterinarian about UYR obtaining the dog's records:

Has your dog ever had obedience training?:

Does your dog get along with other dogs?:

Does your dog get along with cats?:

Does your dog get along with children?:

Has your dog ever bitten a person and broken the skin?:

Why are you surrendering your yorkie?:

Are there any other important things we should know about your dog?:

Have you contacted other groups about surrendering your dog?:

If so, who?: