Animal Surrender/Intake Request

Pig Surrender/Intake Request
Date*

MonthDayYear
Date
Name*

First NameLast Name
Your Email*
Your Phone*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Date of Birth*

MonthDayYear
Date
Pig's Name*
Color/Breed*
Gender*
Spayed/Neutered*

YesNoUnknown
Age*
Approximate Weight*
What is your reason for surrender?*
How long have you had this pig?*
Where did you get this pig?*
Does this pig live primarily indoors or outdoors?
Is this pig micro chipped?*

YesNo
Has this pig bitten anyone in the last 30 days? If so, please explain.*
Does this pig have/had any known medical issues? If yes, please explain.*
Any potential behavioral issues?*

AnxietyChewingDigging/rootingBeggingChargingInappropriate urinatingDisplays of protection of house, family, etc.JumpingBitingAggressionFear of noises and/or objectsNo behavioral issuesOther
How is this pig with cats?*
How is this pig with dogs?*
How is this pig with children?*
How is this pig with strangers?*
Has this pig ever injured or killed another animal?*
Has your pig had any vaccinations?*
What do you currently feed the pig?*
Veterinarian Name*

Dr. NameClinic Name
Veterinarian Phone Number*

Area CodePhone Number
Is this pig trained to any of the following?*

HousebrokenLitter Box TrainedCrate TrainedHarness TrainedRamp Trained
Does this pig know any tricks/commands?*
Are you prepared to make an upfront donation of $2,000 to support this pig for the remainder of their life? (Low end cost of food & vaccinations alone is approximately $350 per year and life expectancy of a pig is 15-20 years. For a 1 year old pig that does not require spay or neuter, their minimum lifetime care costs would be at minimum, somewhere around $4,900-$6,650.)*

YesNo
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Pig Surrender/Intake Request