Critter Surrender Appointment Request 11.4.21

Critter Surrender Appointment Request

Please set aside 15 minutes to complete the form in its entirety.
Today's Date *

Month Day Year
Date
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
What is your preferred method of contact? *
Which days of the week and times would you be available for appointments and/or contact? *
How long have you owned this pet? *
Where did you get this pet? *
REASON FOR REQUEST
What is your reason for requesting to surrender this pet? (Please check all that apply) *

Behavior issue (aggression, separation anxiety, destructive behavior, etc.) Too many animals Pets do not get along Doesn't fit my lifestyle/don't have time Allergic to pet Moving (can't take pet) Divorce, separation, or loss of head of household Owner deceased/pet abandoned by owner Military deployment Lost job Eviction/lost home (need temporary housing/boarding) Can't afford to care for pet (pet food, supplies, veterinary care) Can't find affordable pet-friendly housing/pay pet deposit Emergency or planned hospitalization/short term injury or illness Fleeing domestic violence Other Reason
RESOURCES
Many pet owners face challenging situations and feel that turning their pet into a shelter is their only option. Depending on your situation, there may be resources available to you that would allow you to keep your pet! Please visit our Resources to Keep Your Pet webpage to find tips on how to rehome your pet and find assistance getting affordable medical and pet care, behavior advice and training, support services for owners in need, temporary foster care for your pet, and help to find pet-friendly housing.
Training/Behavior Help

Often behavior issues can be addressed with minor changes to your routine or household. We can assist you with troubleshooting minor behavioral issues or refer you to appropriate resources for more severe problems.

Please view our Pet Behavior Tips on our webpage for videos with information and guidance.

Some behavioral issues can be a symptom of underlying medical issues and can be easily fixed by receiving veterinary care.

Please click this link to view a list of affordable veterinary services and assistance.
No Time for Pet

Pets can benefit from environmental enrichment. Setting aside a few minutes each day to make their lives more interesting could make a big difference to their behavior. And don't forget pets reduce personal stress and can add years to your life.
Rehoming

There are many people in the Valley looking for a new pet just like yours. Before considering surrendering your pet to a shelter, see if you can find another family who may be interested in giving your pet a new home. Visit our Rehoming Your Pet section of our Surrender Your Pet webpage for tips on how to re-home.
Managing Pet Allergies

If someone in your home has been diagnosed with allergies by an allergist, carefully consider if you can live with or manage the symptoms. Children may outgrow pet allergies while others are able to manage their symptoms and keep their pets in their homes. To learn more, visit our Resources to Keep Your Pet webpage - Managing Pet Allergies.
Finding Pet-Friendly Housing

We get it - life happens! And we know you want the best for your animal. If your life change is anticipated, we recommend doing everything possible to rehome your animal on your own. If you have recently lost your home or need to move, we can sometimes assist with navigating rental policies on having animals or finding pet-friendly housing. Please download tips on how to Conduct a Successful Housing Search and how to Rent Successfully with Pets.
Finding Pet-Friendly Housing

We know you want the best for your animal. If you need to move due to a domestic violence situation or house instability, we can assist with navigating rental policies on having animals or finding pet-friendly housing. Please download tips on how to Conduct a Successful Housing Search and how to Rent Successfully with Pets.
Low-Cost Veterinary Care, Vaccines, Spay and Neuter, Pet Food and Supplies

We offer a variety of resources that may help you care for your pet during this time of crisis.

Veterinary Services and Assistance

Pet Food Assistance
Resources for Pet Owners in Crisis

If you currently experiencing a crisis (i.e. eviction or loss of housing, emergency or long-term medical or behavioral health hospitalization, short-term injury or illness, or seeking safety from domestic violence), you can find information about eviction, rental, mortgage, and utility assistance programs as well as domestic violence support services. We may be able to help through our Bridge the Gap program. Apply through this link or contact us for more information.
Bridge the Gap

AHS, in partnership with the Nina Mason Pulliam Charitable Trust, has launched the Bridge the Gap program to support pet owners in crisis.

As part of the Bridge the Gap program, the Arizona Humane Society has the Real-Time Solutions Fund. This fund is a one-time grant to assist pet owners in need who are financially struggling to keep their pets due to unforeseen hardship. If you need assistance with paying for a Pet Deposit, buying supplies that will help you keep your pet safe with you (i.e. crates, outdoor kennels, other pet supplies) or your pet is in need of medical care that you are unable to afford at this time, you can apply for assistance.

Click this link to complete the Bridge the Gap Pet Family Resource Referral form.
Would 90 days or less of Temporary Care prevent your need to surrender? *

Yes No
Temporary Foster Care for Pet Owners in Crisis

Our Project Home Away From Home program provides temporary foster care (typically 30-90 days) for the pets of families in a critical time of need. This could include situations such as medical or behavioral health hospitalization, domestic violence survivors seeking safety for themselves and their pets, or for those experiencing a loss of stable housing due to unforeseen circumstances. Your pet must pass the behavior and medical exam to be accepted. If you are experiencing a crisis and need temporary foster for your pet, click azhumane.org/tempcare to apply for Project Home Away From Home.
CRITTER PROFILE

The information provided here will assist us in evaluating and attempting to properly place the pet you are surrendering. Please complete this profile as thoroughly as possible. Thank you.
Your Pet's Name? *
Species? *
Please Note: We do not accept fish, reptiles, birds, ferrets, or exotic pets.
Breed? (If unsure, please enter unknown.)
Gender? *
Approximate Age? (Years/Months/Weeks) *
Color? *
Does your pet have a microchip, tattoo, or other identification? *
If your pet has a microchip that is not registered to you, we must speak with the person the chip is registered to prior to surrender.
Medical Information
Has this pet ever been seen by a veterinarian? *

Yes No
Please list the veterinarian and any known health issues: *
Does this pet have any urgent medical needs? *

Yes No
Please describe: *
Is this pet possibly pregnant? *

Yes No
Behavioral Information
Is this pet litter box trained? *

Yes No
Is this pet used to being handled regularly (hand-tamed)? *

Yes No
Has this pet ever bitten anyone? *

Yes No
Please list the date of the last bite: *
Please describe the circumstances in detail (i.e. age of victim, body part bitten, severity of bite, what started the aggressive behavior, etc.? *
Homelife Information
Has this pet live with: (check all that apply) *

Dogs Cats Children Other
Where does this pet live? *

In a cage/hutch Aquarium Free range indoors Free range outdoors
What is the approximate size of enclosure?
What kind of bedding/litter do you use if any?
How often is this pet's cage/habitat cleaned?

Daily Weekly Other
What have you been feeding this pet? *
Additional Information
Is there anything else a future owner should know about this pet? *
Should be Empty:

Critter Surrender Appointment Request

REASON FOR REQUEST

RESOURCES

CRITTER PROFILE

Medical Information

Behavioral Information

Homelife Information

Additional Information