Owner Surrender Information Form

The primary mission of Bichon Rescue of Orange County (BROC) is to help Bichons and other small breeds that can no longer be cared for by their owners. Although we concentrate our efforts on those in shelters or who have been abandoned or rejected, we realize that there are families who may no longer be able to care for them. We review and evaluate each surrender based on the information provided.

Please read the information on our Surrender Process page before completing this form.  We will contact you to arrange a time to evaluate your dog and will advise you of the surrender donation following evaluation.


Your Contact Information

Reason For Surrender

IMPORTANT: If you wish to surrender more than one dog, you must complete a separate form for each dog.

Information about the dog you wish to surrender

This dog's daily routine

Tell us how this dog gets along with others

Health information for this dog

Additional Information

Signature