ANIMAL SURRENDER FORM
YOUR DETAILS
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
PET'S DETAILS
Pet's Name
*
Why do you want to surrender your pet?
*
Type of pet
*
Cat
Dog
Breed of Pet
*
Age of Pet
*
Are you the legal owner of your pet? If not who is?
*
Where did you get your pet from?
*
If you adopted your pet from a rescue group or animal shelter have you tried to return it to them?
*
If you purchased your pet from a breeder have you tried to return it to them?
*
How long have you had your pet?
*
Who does the pet live with?
*
If applicable, please list any animals that your pet lives with:
*
Please upload a photo of your pet:
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Has your pet been:
*
Desexed
Vaccinated
Microchipped
Worm treated
Flea treated
Please list any past or present medical conditions your pet may have, including allergies:
*
Please list any medications or supplements your pet takes:
*
How often does your pet visit the vet and which veterinary clinic do you go to? If applicable do you consent to us contacting the clinic for your pet's medical history?
*
Has does your pet ever shown aggression towards:
*
Men
Women
Children
Cats
Dogs
Pocket pets
Livestock
Has never shown any aggression
How would you describe your pet's personality:
*
Friendly
Scared
Affectionate
Outgoing
Shy or reserved
Playful
Timid
Cautious
Unpredictable
Other
Where does your pet sleep?
*
Where does your pet spend most of it's time:
*
Inside
Outside
Outside during the day/ Inside at night
Inside during the day/ outside at night
Please describe the type of home that would best suit your pet?
*
What date does your pet need to be moved on by?
*
-
Day
-
Month
Year
Date
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DOGS ONLY
Is your dog friendly with other dogs?
No
Selective
Yes, with all dogs
Yes, big dogs only
Yes, small dogs only
Unsure
How does your dog behave towards familiar dogs?
Friendly
Wags tail
Barks
Growls
Lunges
Scared
Warms up quickly
Jumps on
Other
How does your dog behave towards unfamiliar dogs?
Friendly
Wags tail
Barks
Growls
Lunges
Scared
Warms up quickly
Jumps on
Other
Has your dog ever been in a fight with another dog? Please explain the situation:
Please describe what interaction your dog has had cats and how they react:
How does your dog usually behave towards familiar people?
Friendly
Wants pats
Wags tail
Growls
Lunges
Scared
Warms up quickly
Jumps on for cuddles
Barks
Hides
Other
How does your dog usually behave towards unfamiliar people?
Friendly
Wants pats
Wags tail
Growls
Lunges
Scared
Warms up quickly
Jumps on for cuddles
Barks
Hides
Other
Has your dog ever been bitten or attacked a person? Please describe the situation:
Is your dog friendly with children?
Yes, all ages
Yes but older than 10 years
Not suitable for a home with babies/toddlers
No
Unsure/ not tested
Does your dog display any of the below?
Excessive barking
Escaping the yard
Separation Anxiety
Lunging/ Barking at passing humans/animals/traffic
Destructive behaviour such as destroying furniture, items of clothing etc
Aggression around food
Other
Is your dog house trained?
Yes- rarely has an accident
No
In the process of learning
Unsure
What training has your dog had?
Puppy School
Obedience classes
Private dog trainer
Unsure
None
Does your dog require specific fencing? E.g: 6 foot and above, colourbond etc.
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CATS ONLY
How does your cat usually behave towards familiar people?
Friendly
Wants pats
Growls/ Hisses
Scared
Warms up quickly
Hides
How does your cat usually behave towards unfamiliar people?
Friendly
Wants pats
Growls/ Hisses
Scared
Warms up quickly
Hides
Please describe what interaction your cat has had with other cats and how they react:
Please describe what interaction your cat has had with dogs and how they react:
Has your cat ever been bitten or attacked a person? Please describe the situation:
Is your cat friendly with children?
Yes, all ages
Yes but older than 10 years
Not suitable for a home with babies/toddlers
No
Unsure/ not tested
Does your cat display any of the below behaviours?
Spraying urine
Toileting outside its litter tray
Biting people
Clawing furniture excessively
Climbing curtains
Other
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DECLARATION
Is there anything further that you would like to add:
I am the legal owner of the above mentioned animal
*
Yes
No
I confirm that this animal has not been declared dangerous and there are no outstanding fines, complaints or local council orders regarding this animal
*
Yes
No
By signing below I certify that the information provided is accurate and truthful to the best of my knowledge
*
Yes
No
I understand that if Ollie's Legacy Incorporated can take my pet I am willing to pay a surrender fee towards its care while its waiting to be adopted
*
Yes
No
Maybe
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