Surrender Request Form

Surrender Request Form

Pet surrenders are only scheduled as space allows so we do suggest that you attempt to rehome on your own when possible. Resources to help keep your pet or rehome responsibly can be found at: https://www.kalcounty.com/ac/Animal_Resources.htm . 
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
What type of notification would you prefer for appointment details or further questions to be relayed? *
Date of Birth*

MonthDayYear
Address (Must Match DL/ID Card)*

Street Address

Street Address Line 2

CityState

Zip Code
Physical Address (If Different than ID)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you surrendering this pet(s) due to a bite, citation, or notice letter from the County, or other legal process? *
If you stated yes above, which reason

Bit a Person (Within the past 10 days)Bit a Person (More than 10 days ago)Citation or NoticeEviction/Loss of ResidenceOther
Please provide in detail the reason(s) you are surrendering your pet?*
The more information listed the better we are able to serve you and your pet.
What resources do you need to prevent you from surrendering your pet(s)?*
What is your pet's name?*
What type of pet are you surrendering?*

DogCatOther
What is the age of your pet? *
What Breed(s) is your pet if known.
Is your pet sterilized (fixed)? *
How long have you had the pet?*

3 weeks or less1-6 months6 months to 1 yearMore than a year
How did you acquire the pet?*

Kalamazoo Animal ServicesOther Shelter/RescueBreeder/ Pet StoreOther
If obtained through Shelter/ Rescue, please name which below:
Many rescues groups and private shelters have in their contracts that you must return the animal to them if needing to surrender. If this is your situation you should reach out to them first.
Is your pet microchipped?*
Is your pet sick or injured?*
Please list any known medical conditions:
Please select a good, clear, picture of your pet. Then click the upload button to upload picture. Note: the picture will be available on the website and better pictures may result in sooner appointments.*

Cancelof
I understand that owner surrenders are by appointment only and surrender fees will apply at time of intake. $40 Per Cat, $40 Per Dog*

I understand
It is my responsibility to provide transportation for the pet to our location at the appointed time of surrender. KCASE staff are not able to pick up owner surrendered pets.*

I understand
Kalamazoo County Animal Services & Enforcement is not a "no kill" shelter. Upon physical surrender, ownership is immediately transferred to Kalamazoo County Animal Services & Enforcement and your pet could be euthanized.*

I understand
By submitting this request, I am certifying that I am the legal owner of the pet I am turning in and that I am relinquishing all ownership rights to the described pet to Kalamazoo County Animal Services & Enforcement. The pet described could be: placed for adoption, euthanized, or transferred to another shelter/animal welfare group.*

I understand
If multiple individuals own the animal (I.e. husband-wife; adult child-parent) or might have an ownership interest in the animal, I have their consent to surrender the animal*

Yes, I have consentNo, I do not have consent
Should be Empty: