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Surrendering my pet for adoption
Please give as as much detail on your pet so we can place your pet in the best home possible. We are a no-kill Animal Rescue and your pet will not be euthanized.
Date
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Month
-
Day
Year
Date
Your Information
*
First Name
Last Name
If your an Animal Organization - Business Name
Phone number
*
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Email - You will be sent a copy
example@example.com
What Type of Surrender
Transfer from another rescue
Medical case (i.e. Cleft Palate)
Owner has passed away and I have authority to surrender
Returned Adoption
Owner Release
Other
STOP AND READ!!! IF THIS IS A RETURNED ADOPTION THAT YOU HAVE HAD IN YOUR CARE LONGER THAN 1 YEAR, YOU UNDERSTAND THAT YOU MUST PROVIDE ANY VETTING RECORDS FOR VISITS DURING THE TIME THE ANIMAL WAS IN YOUR CARE WHICH INCLUDES BUT IT NOT LIMITED TO ILLNESS CARE/VACCINATION HISTORY AND HW TESTING (DOGS). IF THIS APPLIES TO YOU, PLEASE TYPE "I UNDERSTAND." IF IT DOES NOT APPLY TO YOU, TYPE "N/A"
Why are you having to Re-home/Transfer your pet
If your animal is exhibiting a BEHAVIORIAL issue (i.e. screaming, separation anxiety, eliminating outside of the litterbox), have you taken your animal to see a vet?
*
Yes
No
Does Not Apply
If your animal is exhibiting a BEHAVIORAL issue, have you consulted a trainer?
*
Yes
No
If you have consulted a trainer, please upload ALL records.
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If your animal is exhibiting ANY behaviorial issues (humping, eliminating in inappropriate areas), please detail.
Pet's name (if applicable)
Male/Female
*
Male
Female
Date of Birth if known if not please put estimated age
*
If surrendering a neonate cleft baby, please let us know:
*
The neonate cleft has not been fed
The neonate cleft attempted to nurse from mom
The neonate cleft has been dropper/syringe fed
The neonate cleft has been bottle fed
Does Not Apply
If you chose one of the feed options above, please detail how much was fed.
Breed of your pet
*
Color or pattern of your pet
*
Is your pet spayed or neutered
*
Yes
No
Is your pet Microchipped
*
Yes
No
Chp Infromation, Click all that apply
Not Scanned
Scanned - No Chip
WIll need a chip
Has a Chip - Please transfer as ownership is being transfered
Do not know if there is a chip
Other
First Picture of your pet
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Second Picture of your pet
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Third Picture of your pet
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Complete Bio of your pet. This helps find the right home.
*
Select all that apply
*
Does not like kids
Great with Kids
Prefers older kids
Likes Cats
Does not like Cats
Is dog selective
Only gets along with opposite sex
House trained
Needs to be crated
Does not need to be crated
Has been trained to walk on leash
Needs to learn to walk on leash
Pulls when walking
Likes to cuddle
Sleeps in my bed
Sleeps in a crate
Outside dog
Does not like to be ;picked up
Has the animal you are surrendering ever shown aggression of any kind?
*
Yes
No
If you answered yes to the previous question, please provide specific detail below.
Has the animal you are surrendering ever bit anyone?
*
Yes
No
If you answered yes to the question above, please provide specific detail. Include the type of bite, severity, if the animal was place in rabies quarantine, etc.
By typing “I confirm,” you are confirming you have disclosed any behaviorial, aggression or bite history to the rescue. If the animal shows aggression after surrender that is a liability to the rescue and its volunteers, you understand that you may be asked to take the animal back or euthanasia may be considered.
*
Has your pet had all vaccines?
*
Yes
No
If you had your pet since a puppy or kitten did he/she receive AT LEAST 3 set of vaccines? This helps us place your pet in a safe foster home. Please list how many sets you know your pet has had.
*
Has your pet had a Heart Worm test in the past year?
*
Yes
No
Not applicable
Is your pet been on any prevention like Heart Worm or Flea prevention?
*
Yes
No
If you answered yes to the question above, what is the name of the prevention?
If this is a returned adoption within a year, if your pet(s) are exhibiting potential health issues (ie peeing outside the litterbox), did you take your pet to the vet?
Yes
No
If this is a returned adoption that has been owned longer than 1 YEAR or an animal being surrendered over 6 months, please provide the NAME and PHONE NUMBER of the vet that the animal has seen.
If this is a returned adoption that has been owned longer than 1 YEAR, you understand you must provide ALL vet records and you understand that if an animal's vaccines or HW test expired within three months of the surrender date, you must update these prior to surrender and prior to the rescue taking possession of the animal.
Yes
No
Not Returned Adoption
Any medical notes? Example: Due for vaccines, has not ever been on prevention etc.
*
Is the animal you are surrendering exhibiting any symptoms of being sick? (PLEASE BE HONEST. WE ARE FOSTER BASED AND HAVING COMPLETE INFO HELPS US PROTECT THE ANIMALS IN OUR CARE AND PROPERLY BE ABLE TO PLACE THE SURRENDERED ANIMAL.).
*
Yes
No
If sick, does your animal exhibit any of these symptoms? These are symptoms of PARVO/PANLEUK for dogs and cat
Nausea/Vomiting
Diarrhea
Weight Loss
No Appetite
None of these symptoms
If you answered YES to the previous question, please describe your animals illness and any actions you have taken. PLEASE BE VERY SPECIFIC and THOROUGH.
Do you you understand that if this is a returned adoption that you must hold the rescue has space to receive the animal?
I understand
Not a returned adoption
Do you understand that if this is a returned adoption you are responsible for getting the animal to their specified return location?
I understand
Not a returned adoption
Do you understand that if the animal you are surrenderiing is exhibiting symptoms of illness that was not disclosed, we may rescind our offer to take your animal into our program?
I understand
Please upload any vet records.
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Additional vet records if needed
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Name of Fuzzy Texan Contact that approved intake you must have approval by a Fuzzy Texan representative. If you submit the form without any approval, the form is invalid.
*
You must have approval from a FTAR rep to surrender an animal. Animals with no approved are not accepted.
If your pet is due for any vaccines or tests are you able to pay for these?
Yes
No
By signing this document you agree that all information provided in this document is true to the best of your knowledge. If you have surrendered your pet, you acknowledge you or your organization are the SOLE owner of this animal and agree to have given up all rights to your pet. By signing you understand that, we do not and will not guarantee you will be eligible to adopt your pet back after they reach adoptable age. You understand we are not an organization that raises pets for individuals and returns them when age appropriate. We do promise to place your pet in a new home that has passed our qualifications.
*
I agree
I do not agree
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Signature
*
Date
*
-
Month
-
Day
Year
Date
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