Payday Loans
jcccare_logo
Surrender Request Form

Surrender Form

This form is for individuals or rescue groups who wish to notify JCCARE of a Japanese Chin dog in need.


Please complete the following form. Fill in all contact information and be as specific as possible. We cannot help if we have incomplete information. Upon submission, a JCCARE rescue representative will contact you.

If you prefer, you may contact a JCCARE representative in your state with the following information.

The information submitted on this form will remain confidential.

Japanese Chin's Name
Invalid Input

Age
Invalid Input

Sex
Invalid Input

Color
Invalid Input

Size
Invalid Input

Health
Invalid Input

Temperment
Invalid Input

Has this dog ever behaved aggressively towards a person including biting?
Invalid Input

If ‘yes’, please explain
Invalid Input

Has this dog behaved aggressively toward other dogs?
Invalid Input

If ‘yes’, please explain
Invalid Input

Background - Tell us a little about your Chin's history. Where did you get your Chin?
Invalid Input

Special Considerations
Invalid Input

The dog’s current location

City
Invalid Input

State
Invalid Input

Zip
Invalid Input

Your Name
Invalid Input

Your E-Mail
Invalid Input

Your Phone Number
Invalid Input

Today's Date

Invalid Input

Additional Information or Instructions for JCCARE
Invalid Input

Please upload a picture you have of your Chin
Invalid Input

Captcha
Captcha
Invalid Input