Pet Surrender Application

BGSDR Pet Surrender Application



    • Bluegrass Senior Dog Rescue understands there are times when a family can no longer care for their pet and must seek placement. Our goal is to keep those pets out of shelters and make their transition into a new home as smooth as possible. In order for us to accomplish this, we will need information which helps us find appropriate placement for each animal need. BGSDR does not guarantee every animal will be appropriate for our program and is not responsible for animals who have not been accepted into our program. Preference is given to senior pets, as well as individuals who are forced to give up pets due to terminal illness. BGSDR works with a variety of screened and reputable animal organizations to assist with placement. All animals are required to be current on their vaccines and have proof of vaccines, prior to acceptance into our program. Please complete one form for each separate pet needing placement. We realize that someone other than the owner may be completing this application and not have all available information. Please take the time to gather as much information as possible prior to submitting this form. This will help us to expedite your request for placement. Please provide the following information for us to be able to assist in placement of your pet:
    • Upon receipt of this animal intake application form, volunteers will review the information and you will be contacted shortly. SUBMISSION OF THIS APPLICATION DOES NOT GUARANTEE ACCEPTANCE AND PLACEMENT OF YOUR PET INTO OUR PROGRAM. Should you require assistance with completion of this application, you can call us at (502)542-5948. We are sorry that you have come to a place where you are unable to care for your pet. We hope to be able to assist you and your pet during this difficult time.

    Personal Information


    Pets habits:


    Our Policy

    • It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this animal intake application form..

      All information on this form will be kept strictly confidential! BGSDR does NOT sell or release names, email or other personal information to individuals, agencies or organizations

    Agreement and Signature




    Helping our old friends find new homes where they can live out their days happily ever after.