Owner Surrender Request

Surrender Request

Contact Information
City of Residence*

Palo AltoLos AltosLos Altos HillsEast Palo AltoOther
Upload proof of residency in Palo Alto, Los Altos, or Los Altos Hills. This can be a current ID, lease, or bill.*

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Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Secondary Number
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Pets In Need?*

Online SearchSocial MediaTV / Radio / NewspaperFamily / FriendOther

Surrender Request

Details
Are you the owner or regular caregiver of this pet?*

YesNo
What is your relationship to the owner?*
Where did this pet originally come from? (found, given, shelter/rescue - specify which one.)*
How long have you been caring for this pet?*
How soon do you need to rehome this pet?*
Why do you need to rehome this pet?*
If this pet is deemed unadoptable, I would like to be contacted.*

YesNo
Describe your current home (house, apartment, studio, etc.)*

Surrender Request

Rabbit Health History
Provide the name of your vet clinic (or where your pet received vaccinations):*
Does your pet have any significant or chronic health issues, surgeries, or current medications?*

YesNo
Please describe your pet's health issues, surgeries or medications:*
What brand of food is your pet currently eating?*
Has your rabbit received a vaccine for Rabbit hemorrhagic disease (RHDV2)?

Yes, one vaccineYes, two vaccinesNo
Has your rabbit exhibited any of the symptoms below?

YesNoNot sure
- Bleeding from nose, mouth, or anus
- Bruising, swelling
- Lethargy, weakness, collapse, inability to stand, paralysis
- Jaundice (yellow discoloration of skin, eyes, gums)
- Decreased awareness/responsiveness, vocalizations
- Difficulty breathing, nasal discharge, congestion, conjunctivitis, bluish mucous membranes
- Incoordination, abnormal body position or posture, spasms, seizures
- Fever
- Lack of appetite, weight loss, bloating, diarrhea

Surrender Request

Health
Provide the name of your vet clinic (or where your pet received vaccinations):*
Does your pet have any signficant or chronic health issues, surgeries, or current medications?*

YesNo
Please describe your pet's health issues, surgeries or medications:*
What brand of food is your pet currently eating?*

Surrender Request

Behavior History
Does your cat like to be petted?

YesNo
What does your cat do when they have had enough petting?
Does your cat like to be picked up?

YesNo
What does your cat do when they don't want to be picked up?
Where does your cat not like to be touched?
Is your cat afraid of, or uncomfortable with, any of the following?

StrangersWomenMenChildrenInfants
What does your cat do in response to people they are uncomfortable with?
What does your cat do if they act aggressive?
What do YOU do if your cat acts aggressive?

Surrender Request

Personality
Check all that apply to your dog's personality.*

FriendlyShyIndependentFearfulPlayfulAffectionateAloofAggressiveOverly Reactive
What is your dog afraid of?*
Where is your dog sensitive about being handled (ears, feet, etc.)?*
When does your dog become irritated?*
What is your dog's favorite game or toy?*
What is your dog's worst quality?*
What is your dog's best quality?*

Surrender Request

Rabbit Behavior History & Personality
Check all that describe your pet's personality.*

FriendlyShyIndependentFearfulPlayfulAffectionateAloofAggressiveOverly Reactive
What is your rabbit's favorite toy or activity?*
What is your rabbit's favorite food?*
What is your rabbit's worst quality?*
What is your rabbit's best quality?*

Surrender Request

Behavior History & Personality
Does your pet liked to be picked up?
Does your pet like to be petted?
Check all that describe your pet's personality.

FriendlyShyIndependentFearfulPlayfulAffectionateAloofAggressiveOverly Reactive
What is your pet's favorite toy or activity?
What is your pet's worst quality?
What is your pet's best quality?

Surrender Request

Additional Information
Upload a current photo of your pet.*

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Upload any medical records.

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Please verify that you are human*
Include any additional information about your pet that would be helpful to Pets in Need or a new owner. This will help us make the best possible match for a new home.
Should be Empty:

	No Reaction	Curious	Barking	Avoidant	Other
The postman or delivery person comes to your door.
Someone knocks on your door.
A visitor comes into the house.
A visitor tries to pet them inside your home.
A stranger approaches you while they are on a leash on a walk.
A stranger attempts to pet them while they are on a leash on a walk.
Someone goes near the food bowl when they are eating.
Someone tries to take away toys, chews, or anything else they value.
Someone hugs them.

Surrender Request