APE Animal Surrender Form

  • Animal Protection & Education

  • Animal Surrender Form & Temperament Questionnaire

  • Please note, we are not animal control.  Iowa law only allows stray animal intakes if you hold a pound license and you have a contract with the community the animal was found in.  We are a shelter, and do not hold a pound license, and therefore can not take in strays.

    Additionally, Animal Protection and Education (APE) cannot take in all animals that are requested to be surrender.  Filling out this form DOES NOT imply APE will be able to accept your animal into APE's shelter program.

  • General Information

  • I am a*

  • Species*
  • Health?*

  • How old was this animal, when separated from littermates / mom?*

  • How long have you had this animal?*

  • How did you acquire this animal?*

  • Approximate age*
  • Approximate Weight*

  • What is this animal's gender?*

  • Cat Behavior and Training Information

  • Socialization*

  • How does this cat behave around men?*

  • How does this cat behave around women?*

  • How does this cat behave around children under 10 years old?*

  • How does this cat behave around animals?*

  • How does this cat behave around other animals and high value food, treats or toys? Check all that apply:*

  • Housebreaking training?*

  • Car rides?*

  • Nail trimming?*

  • Has this animal ever bitten anyone?*

  • Dog Behavior and Training Information

  • Socialization*

  • How does this dog behave around men?*

  • How does this dog behave around women?*

  • How does this dog behave around children under 10 years old?*

  • How does this dog behave around strange dogs?*

  • How does this dog behave around other dogs and high value food, treats or toys? Check all that apply:*

  • How does this dog behave around cats?*

  • Leash/Collar training?*

  • Housebreaking training?*

  • Fences?*

  • Car rides?*

  • Nail trimming?*

  • Has this animal ever bitten anyone?*

  • Bite History Information

  • WHERE DID THE INCIDENT TAKE PLACE?*

  • IN THE CONTEXT OF THIS INCIDENT, DID THE ANIMAL:*

  • HAD THE ANIMAL ATTEMPTED SUCH ESCAPE IN A SIMILAR SITUATION BEFORE?*
  • WAS THE ANIMAL ON OR OFF LEASH?*
  • DID THE ANIMAL KNOW THE PERSON BITTEN?*
  • DID THE ANIMAL OR PERSON APPROACH?*
  • HAS THE ANIMAL EXHIBITED ANY OF THESE SAME BEHAVIORS IN THESE SITUATIONS?*
  • WAS THE BITE AN ACCIDENT?*
  • WAS THE BITE PROVOKED IN ANY WAY?*
  • DID THE PERSON WHO WAS BITTEN APPEAR IMPAIRED IN ANY WAY, EITHER PHYSICALLY OR MENTALLY?*
  • DID THE BITE RESULT IN INJURIES TO THE PERSON?*
  • WHICH BEST DESCRIBES THE OUTCOME?*
  • WHAT WAS THE SPECIFIC LEVEL OF CARE GIVEN TO THE PERSON BITTEN?*
  • DID THE ANIMAL:*
  • WHAT HAPPENED AFTER THE ANIMAL RELEASED OR WAS MADE TO RELEASE?*

  • WAS THIS AN ISOLATED INCIDENT?*
  • IS THERE A HISTORY OF THIS BEHAVIOR?*
  • WHAT IS KNOWN ABOUT THE ANIMAL’S HEALTH:*
  • HAS THE ANIMAL WORKED WITH OR BEEN EVALUATED BY A TRAINER/BEHAVIORIST?*
  • DOES THE ANIMAL HAVE A VETERINARIAN?*

  • Veterinary Information, Donation Request, Release Agreement, and Signature

  • Please have your vet email copies of the animal's records to: ape.adoptions@gmail.com

  • We will need copies of all vet records.  All animals adopted out are spayed/neutered, given age appropriate vaccinations, microchipped, and tested for Heartworms (dogs) or Feline Leukemia/ FIV (cats).  If these procedures are not completed before the animal is surrendered, APE will have a shleter vet preform these procedures at APE's expense.  However, a donation to help pay for these procedures is always appreciated.

  • The state of Iowa requires all shelters to provide age appropriate core vaccines.  This includes a Distemper combo, and a Rabies vaccination (if the animal is over 6 months of age.)  The state of Iowa also requires all cats and dogs be sterilized before transfer of ownership.  Additionally, some animals need to be treated for parasites such as fleas, and worms, etc.  Along with feeding, testing, microchipping, and housing, it all adds up.  Some funds are re-coup via the adoption fee.  However, it seldom covers all of the costs.  Hence, if you can, we greatly appreciate any donation you could give.  We have a link below that will redirect you to PayPal for your convenience.  Thank you.

  • Donation for Surrendered Animal

    prevnext( X )
    USD

  • Please take 3 good quality, well lit photographs of the animal and email them to us at
    ape.adoptions@gmail.com with your name and the animal's name in the subject of the email.

  •  

    It is understood that A.P.E. does not buy or pay for pets.  This is service to help place your pet in a new home when the present owner can no longer keep them.  This service is free, however, a donation to help pay for expenses is appreciated.


    Conditions of Release:
    I, the undersigned, do hereby unconditionally release my pet to make available for adoption to A.P.E., relinquishing all my rights, title and interests in said animal.  I certify that this pet is, to the best of my knowledge, healthy and does not have any undisclosed sicknesses or diseases, and I have not willfully concealed information about this.   I hereby swear that I am the sole legal owner, or agent for the owner of this animal.   In addition, I hereby swear that this animal has not bitten or scratch any human being or any domesticated animal within the last 10 days.  I agree that in an extreme case, deems unavoidable and necessary for health and/or an unsound temperament the animal maybe humanely euthanized.

  • Date*
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