Las Vegas Rescue Center Animal Surrender Form
lasvegasrescuecenter@gmail.com | lasvegasrescuecenter.org | 702-427-1307
This form is only for animals that have been accepted into our rescue.
Animal's Name
*
Dog or Cat?
*
Please Select
Dog
Cat
Animal's Gender
*
Please Select
Female
Male
Animal's Age
*
Description of animal
*
Where did you get your animal?
*
How long have you had your animal?
*
Why are you surrendering your animal?
*
Is the animal potty trained (if a dog) or litter trained (if a cat)?
*
Yes
No
Choose all that apply. Is your animal:
*
Spayed/Neutered
Up To Date on Shots
Microchipped
None of the above
Do you have records?
*
Yes
No
If you don't have records, what is the name of the Veterinarian hospital where the animal was vetted?
Provide permission for the Veterinarian hospital to provide the animal's medical records:
Does your animal get along with other animals? If so, explain:
Have you reached out to any trainers for your dog if there are behavioral issues? If so, what is the name of the trainer and what was their assessment?
Date of Surrender
*
-
Month
-
Day
Year
Your Name
*
Address
*
City
*
State
*
Phone
Format: (000) 000-0000.
Driver's License #
*
Note: your driver's license must have correct address to surrender an animal.
Signature
Date
/
Month
/
Day
Year
Submit
Should be Empty: