Animal Surrender Form

Please note that this form is an informational application. It does not mean that you have surrendered your pet to Potter's Angels Rescue (PAR) nor does it mean that PAR has agreed to take your pet. We are a foster home based organization and we can not always find immediate placement for animals. Some pets may not be suitable for foster homes due to their temperament but there are other ways we may be able to assist. So please, if you know in advance that you will need to surrender your pet, please get in touch with us right away. If this truly is an animal emergency, please email surrenders@pottersangelsrescue in addition to filling out this form and we will do what we can to assist you.

Full Name*

First Name Last Name

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number*

Area Code Phone Number

E-mail

Why do you need to surrender your Animal?*

Date animal needs to be out by:*

How long have you had this animal?*

Where did you acquire them? *

If you acquired them from another rescue/shelter or breeder, have you contacted them and, if so, what was their response? Reputable rescues and breeders will often have contracts for the dog to be returned to them*

Name*

Age*

Gender*

Breed*

Weight*

If animal is anything other then a dog or cat, please use this space to tell us what it is, and why you need to surrender it.

Veterinarian Name and phone number*

Have you contacted your veterinarian to release records to PAR? If not, please do so asap*

Is this animal current on its vaccinations*

Is this animal spayed or neutered?*

Has this Animal ever bitten a person? If yes, please explain the situation to the best of your ability.*

Will you be providing any of the Animals belongings at time of surrender? (toys, dishes, food, bedding)*

Animals current diet. Please prodive us with the brand of food, how much food you give it, and how often you feed it,*

Has this animal ever lived with any other animals? If yes, please check all that apply*

If Animal has lived with other animals, please tell us how the said animal behaved with them.

Has this Animal ever bitten another animal? If yes, please describe the situation, and if the other animal needed medical care, and or died due to the bite*

Has this animal ever lived with any children/? If yes, please list the age(s) of the children and how the animal interacted with them.*

Please use the space below to tell us any other information you have about this animal.*

Please upload any photos of your dog that you would like included in their write-up- please be sure to re-size images prior to upload to a managable size prior to upload ie: under 500 KB

Please upload any scanned vet records of your dog if possible

I understand that by completing this form Potter's Angels Rescue is under no obligation to take my animal.*

Agree

I am in complete understanding that by submitting this form I am beginning the process of surrendering my animal to Potter’s Angels Rescue, Inc. for adoption. I certify that I am the owner or I have the authority to surrender the animal described above. It is understood that Potter’s Angels Rescue, Inc. will not be obliged to account for the disposition or overall health of the animal. I understand that by submitting this form I will relinquish all rights of this animal to Potter's Angels Rescue, Inc. upon the mutual agreement of both parties to place the animal into the foster program.*

Agree

Potter's Angels Rescue Animal Surrender Form

Animals Information