Animal Surrender/Intake Request

Piedmont Animal Rescue
Pet Surrender/Intake Request
If you need to rehome your pet, we accept pets of all types (dogs, cats, reptiles, small animals, farm animals, exotic animals, birds, etc). We can NOT accept Aggressive animals. If your pet fits that criteria, please fill in and submit this form and follow the instructions at the bottom for sending us photographs.
Your Name*
Your Email*
example@example.com
Your Phone*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Animal's Name*
Breed*
Color(s)*
Under 8 weeks8 weeks to 4 months4 months to 1 year1-3 years3-6 years6-9 years9+ years
15 lb or less16-30 lb30-45 lbOver 45 lb
Sweet and socialA little shy but warms up when you're niceVery shyDefinitely abusedFear biter
Has your pet had any vaccinations, heartworm/combo testing, has it been altered (spayed or neutered)? If so, please describe.*
What is your reason for surrender?*
YesNo
YesNo
When we take a pet in, we keep it in our home with our family and pets. Whether it takes weeks or months to find it a home, we keep the pet with us and incur all the cost of it's care and vetting. Our rescue is partially funded by our adoption fees, but this typically does not cover all of our expenses during the year.
Amount of donation offered to help us cover the cost of vetting/caring for this pet?*
Please take 3 good quality, well lit photographs of the pet and email them to us at
info@piedmontanimalrescue.com with your name and the animal's name in the subject of the email. If you have any videos of the pet, please send us the links to them on youtube.
Picture #1*

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Picture #2*

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Picture #3*

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Medical Records

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Please verify that you are human*
Should be Empty:

Piedmont Animal Rescue

Pet Surrender/Intake Request