Surrender Application

RESCUE ANIMALS COMMUNITY EFFORT

503 Red Fox Street NW, Shallotte N.C. 28470

910-579-0407

racerescue@atmc.net
ANIMAL REHOMING ASSISTANCE FORM
Contact Information:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
email
example@example.com
In order for RACE to better understand the animal and find it a suitable home, please answer the following questions honestly:
DogCatOther
Name of Animal
Breed of Animal
Color of Animal
Approximate Age
Gender
YesNo
Where did you get this animal?
How long have you had this animal?
Veterinarian Name
Veterinarian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Describe any current/past health issues, injuries and/or special needs. Please provide any tags, licenses, medicine, etc when surrendering the animal.
Brand of food
Favorite toys/treats
MenWomenChildrenSeniorsOther
If living with children, what age of each
FriendlyPlayfulTimidFrightenedAggressiveNo Experience
FriendlyPlayfulTimidFrightenedAggressiveNo Experience
FriendlyPlayfulTimidFrightenedAggressiveNo Experience
FriendlyPlayfulTimidFrightenedAggressiveNo Experience
FriendlyPlayfulTimidFrightenedAggressiveNo Experience
FriendlyPlayfulTimidFrightenedAggressiveNo Experience
QuietLoudActiveOther
LowMediumHighVery High
The animal has been kept:
How is the animal confined?
Has the animal bitten anyone?
Is the animal housebroken?
Why are you surrendering this animal?
Surrender Authorization:

I certify that I am the legal guardian (owner) of said animal and have complete authority to surrender said animal to RACE Inc. I hereby release possession, title and any claims to said animal to RACE Inc and it’s representatives and I certify that I will not make any attempt to reclaim said animal at any point in the future. RACE Inc reserves the right to refuse to accept any animal at the representative's sole discretion.
Signature
Printed Name
I understand and accept the terms for which RACE Inc will re-home my animal is conditioned upon all animals within my possession to be spayed or neutered at no cost to me.
Signature
Printed Name
Donations are encouraged to offset expenses incurred in the rehabilitation and care of animals before placement in a new home. We at RACE Inc understand that uncontrollable circumstances sometimes arise that make it difficult to properly care for or safely keep a pet in your home.

Thank you for caring about the welfare and happiness of this animal.
RESCUE ANIMALS COMMUNITY EFFORT

PO BOX 3370, Shallotte N.C. 28459

910-579-0407

racerescue@atmc.net
Should be Empty:

ANIMAL REHOMING ASSISTANCE FORM

In order for RACE to better understand the animal and find it a suitable home, please answer the following questions honestly: