Small Animal Owner Surrender Form

If you need to surrender your dog to the HH, please fill out the form below. A staff member will contact you after reviewing the information. The HH is an open admission adoption facility that accepts cats, dogs, and small animals for surrender.

We ask for (but do not require) a $50 donation at the time of surrender in order to help us offset the cost of care for the animal during their stay.

Owners Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Animals Name

Age

Breed

Dog, Cat, etc

Color/markings

Please indicate if your dog is spayed or neutered.(required)"Intact" means your pet has not had surgery to be sterilized.

Please explain why you need to surrender your animal

Where did you get him/her?

How long have you had him/her?

If surrendering a feline. Please answer the below. What type of litter box is the cat used to? What type of litter is the cat used to? How often is the litter box cleaned? Where was the litter box located? Does that cat have accidents outside of the litter box?

If surrendering a Small Animal (Guinea Pig, Rabbit, Gerbil, Hamster, Mouse, Rat, Chinchilla, Bird) please answer the following. What type and size of housing did your pet have? What type of bedding was used? Does (s)he ever get possessive of his/her space? How often does your pet spend time out of his/her cage? How often is your pet handled by people?

If surrendering a canine please answer the following. Has the dog had any training? If so, where? What commands/cues does the dog know? How would you describe the dog's personality? Does the dog have any "bad habits"? How does the dog do in the car? How does your dog respond to strangers? Please be specific. How does the dog react to other animals when ON a leash? How does the dog react to other animals when OFF leash?

Please list any of your pet's favorite toys/activities

How do they interact with Children?

Interact with other animals

Veterinary Name

Date of Last Vet appointment

Up-to-date on vaccines?

Does the animal have to be sedated or muzzled at the vets?

Please list anything you would want a potential adopter to know about.

Does your animal have any past or present medical issues or special dietary requirements?

Please list any medications

Type of food and how much

Date of last prevention and type

Does the dog growl during certain circumstances? Please describe

Have you ever been concerned about the dog's behavior for any reason?

Has the dog ever injured or killed another animal?

Does the dog have a favorite treat? What is the dog's reaction to being touched or having the food bowl moved while he/she is eating? Do you give the dog rawhide bones or anything similar? What is the dog's reaction if you need to take something away?

How would you describe the dog's activity level? Where is the dog primarily kept? When outdoors, how is the dog confined? What type of collar, harness, or head halter do you use? Does the dog have any favorite toys or games?

Is the dog housetrained? How often does he/she go out? How does the dog let you know when he/she needs to go out? How often does he/she have accidents in the house? How many hours per day is the dog left alone? Where is he/she kept when alone?

How is the dog when left alone? Does he/she chew or destroy things? Where does the dog spend most of his/her time when you're home? Where does the dog sleep at night? Is the dog allowed on the furniture?

Does the cat ever act aggressively? If yes, please explain. Is the cat uncomfortable being touched or handled in any way? Where does the cat spend most of his/her time?

Inside or outside? Does the cat try to escape? How does the cat interact with children? How does the cat behave around visitors? Do you trim your cat's nails? If not, who does?

Spayed/Neutered

Use a litter box

Walk on a leash with a harness?

What type of food is (s)he used to eating? What types of vegetables, treats, or other supplements is (s)he used to eating?

Please have medical records from your current vet emailed over to healingandhopeanimalfoundation@gmail.com. This includes past results of any bloodwoork, heartwork test results, tick test results. It is important for us to receive the most recent medical records as this allows us to have past records to look at. Many new homes also like to have these to give to their vets.

Signature

Small Animal Owner Surrender Form

Dog

Feline

RABBITS/FERRETS