Animal Surrender Form
Please fill out this form if you are wanting to surrender your domesticated animal to the Stafford County Animal Shelter.
Owner's 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.
Format: (000) 000-0000.
Email
*
example@example.com
Animal Information
Type of Domesticated Animal:
*
Cats
Dogs
Other
Gender of Animal
*
Male
Male Neutered
Female
Female Spayed
Otherwise Unknown
Hair of Animal
*
Short Hair
Medium Hair
Long Hair
Is your feline declawed?
*
Yes
No
Does the dog behave well in the car?
*
Yes
No
If yes, please explain the behavior in the car:
*
Breed of Animal (if known)
*
N/A if you don't know
Name of Animal
*
Age of Animal
*
How long have you owned/lived with the animal?
*
Where did you acquire the animal?
*
Reason for surrender:
*
Did you get this animal from a rescue?
*
Yes
No
Name of rescue where animal was acquired from:
Did you contact the rescue that you got the animal from?
*
Yes
No
Other
Has it seen a veterinarian?
*
Yes
No
If yes, who?
*
Is the animal up to date on vaccinations?
*
Yes
No
If yes, are you able to provide us the applicable medical records?
*
Yes
No
Upload medical records here:
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Does the animal have any medical issues?
*
Yes
No
If yes, list them here:
Where does the animal spend the largest majority of it's time:
*
Inside
Outside
Both
Other
What brand of food does your animal eat, how much do they eat, and how often?
*
What other animals has the surrendering animal lived with?
*
Cats
Dogs
None
Other
If the animal has lived around dogs, what breed and size?
*
Is your animal friendly with:
*
Cats
Dogs
None
Other
Has the animal lived with any of the following:
*
Young Children (0-10yrs)
Older Children (10+ yrs)
No Children
Does your animal do well with children?
*
Yes
No
If no, explain why:
*
Does your animal do well with grooming (bath, nail trimming, etc.)
*
Yes
No
If no, explain why:
*
Does the animal show any irritation or aggression in any situation (Food, toys, strangers, etc)
*
Yes
No
If yes, what is that behavior:
*
How well does the animal react to being handled and/or picked up?
*
BEHAVIOR: Please check all boxes that apply to the animal:
*
Hides from strangers
Housebroken
Afraid of thunderstorms
Leash Trained
Shows separation anxiety
Crate trained
Knows commands/tricks
None of the above
Other
What is special about your animal that you would like a future "fur-ever" home to know?
*
Please upload photo(s) of the animal:
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Submit
Should be Empty: