LYR Owner Surrender Form

Owner Surrender Form
Kentucky Paws Animal Rescue

25 Dean Hundly Rd East Bernstadt Ky 40729

Email: kentuckypaws@gmail.com

Website: www.kentuckypaws.org
Please complete one form for each animal being surrendered. Kentucky Paws Animal Rescue makes every attempt to find safe and loving homes for the adoptable pets surrendered to us. Please fill out the form entirely. If admitted, the detailed and accurate information you provide us makes it easier for us to place your pet in an appropriate home. Also send a pic with your name and the pets name to (606)-224-5701 If we do not receive a Pic we will not be able to help. Note: do not call just send a clear pic.

We work with other no - kill rescues as well and we will do our best to help this pet. There is a waiting list to enter into rescue so please be Patient with us.

We can not promise that we can help every pet but we can try. If you dont send a pic of the pet in need we can help.
Name:*
Address:*
City/State:*
Zip:*
Contact Number:*
Work Phone:
Email Address:*
example@example.com
Is this a litter of Puppies or kittens?
Type a question
How many in litter?
Pet's Name / If a litter put the mom and dads :*
Sex: Male Female if a litter put how many boys and girls and Age:*
Breed:*
More Details about Your Dog/Cat

PLEASE BE VERY SPECIFIC WITH YOUR ANSWERS SO THAT WE CAN PROVIDE THE BEST CARE FOR AND FIND THE BEST SUITABLE HOME.
Where did you get your dog/Cat?
Is your dog/Cat spayed or neutered? Yes No
How long have you owned your dog/Cat?
Why are you surrendering your dog/Cat?
Is your dog/Cat destructive when left alone? Yes No
If yes, please explain:
Is your dog/Cat house trained/Litter box trained?
What cues does your dog know, if any?
Is your dog crate trained?
Has your dog had previous training? Yes No
What veterinary does your dog/Cat go to?
When was your dog last at the vet?
When was your dog/Cat last vaccinated?
Does your dog/Cat have any known health related issues? Yes / No
If Yes please explain.
Has your dog been on Heartworm preventative? Yes / No What kind?
When was your dog last tested for Heartworms?
What was the test result? Positive / Negative?
When was it last given?
Does your dog/Cat currently live with children? Yes / No If yes, what ages?
Please describe your dog's/Cats experience with children:
How Does Your Dog/Cat React?
To strangers?
To visitors in the home?
If you try to take away a toy or bone?
If you take your dog's food while eating?
If your dog/Cat is disturbed while sleeping?
Any additional comments:
Does your dog/Cat live with other dogs? Yes / No How many?
If Yes, What are the age/sex/breeds ?
Does your dog/Cat get along with other dogs? Yes / No
If yes, please explain your dogs/Cat experience with other dogs:
If no, please explain:
Does your dog/Cat get along with other type animals? Yes / No
Does your dog/Cat live with cats? Yes /No
If yes, please explain your dog's/Cat's behavior with cats:
Does your dog/Cat have behavior issues? Yes / No
If yes, please explain:
Does your dog have any fears? Yes /No
If yes, please list all:
How does your dog/Cat react: When being seen by a veterinarian?
When being groomed?
To having his/her nails trimmed?
Has your dog ever bitten anyone? Yes / No
If yes, did it break skin? Yes No
Was a bite report filed? Yes/ No
Please explain the bite incident:
Please list a few things you like best about your dog/Cat:
Why do you think your dog/Cat would be a good candidate for adoption?
Does your dog have any food aggression? Yes / No
If Yes explain.
By signing this form, I state that I am the owner of the animal who is the subject of this Animal Surrender Form. To my knowledge, no other person has a right to this animal. I hereby surrender all rights to this animal. I understand that once I relinquish this animal, the animal will not be available to be returned. I have read and understand the terms of this Animal Surrender Form.

NOTE: JUST BECAUSE YOU FILLED OUT THE FORM DOES NOT MEAN THAT WE WILL TAKE THE PET(S).

WE WILL NEED PIC'S AND IT WILL TAKE SOME TIME TO GET BACK TO YOU. IF YOU HAVE A AGGRESSIVE PET WE WILL NOT TAKE IT.

WE CANNOT TAKE A PET FAST JUST BECAUSE YOU WANT IT GONE TODAY. IF YOU WANT THE PET IN A NO-KILL RESCUE YOU NEED TO BE PATIENT AND LET US WORK. WE WILL NOT FORGET YOU OR YOUR PET(S).
Signature*

Clear
Date

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Date
Should be Empty:

More Details about Your Dog/Cat

How Does Your Dog/Cat React?