Animal Intake Form | Owner Surrender

Owner Surrender - Animal Intake Form

729 E. Hoffer St. | Kokomo, IN 46901 | 765.452.6224 | www.KokomoHumane.org
Are you a Howard County Resident?*

YESNO
Not a Howard County Resident? Please STOP HERE
Thank you for considering our shelter. Due to limited space, we cannot accept animals from outside Howard County. Please contact an alternative shelter or rescue. Also, we highly recommend Independent Pet Rehoming via Rehome by Adopt-a-Pet (See more details HERE).
If you are a Howard County Resident Please CONTINUE >>>
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Cellphone
Alternative Phone Number
Alternative Phone Number
Driver's License Number*
DLN
How urgently do you need to surrender your animal?*
Please describe your timeframe or any deadlines you are facing
Pet Information
What are you surrendering?*

CatDogFeline LitterCanine LitterMultiple IntakeOther

How is the animal with: *

	Other Dogs	Cats	Strangers	Kids
How am I with...

What ages of kids this animal been exposed to?*
ex: 3 years old/7 years old
Is this animal house-trained/uses litter box?*

YesNoUnknown
Is the dog leash trained*

YesNo
Is the dog crate trained?*

YesNo
Is the animal frightened by anything? (e.g. thunder, car, bicycles, etc.)*

YesNo
If so, what is he/she frightened by?*
What are the pet's best qualities?
Does this pet have any bad habits?
What sort of family/ environment would you recommend for this pet?
Does this pet have a bite history?*

YesNo
If yes, please describe:*
Is there any additional informational information you would like to add?
Please upload at least 3 good pictures of the animal(s) you are surrendering*

Browse Files

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Please understand that we will not be able to place every animal

I, the undersigned, owner or having custody hereby agree that the animal or animals above specified have not been involved in a bite in the previous 10 days, and shall be disposed of at the discretion of the Kokomo Humane Society. I further understand that if I change my mind and want to reclaim the animal, it will be at the sole discretion of the Kokomo Humane Society and any applicable adoption fees may apply. The Kokomo Humane Society reserves the right to refuse adoption to any person or organization.
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Owner Surrender - Animal Intake Form