Small Animal Surrender Application
Filling out an application does not guarantee that we will be able to accept your pet into our shelter. This application is for rabbits, guinea pigs, hamsters, gerbils, etc. We are not able to accept reptiles or other exotic pets.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County?
*
Please Select
Geauga
Lake
Ashtabula
Trumbull
Portage
Cuyahoga
Summit
Mahoning
Other
Phone Number
*
Please enter a valid phone number.
Email-if you do not have an email type in: animalintake@rescuevillage.org
*
example@example.com
Pet's Name
*
One pet per form. If you have multiple pets you want to surrender, you will need to complete multiple applications.
Species? (Ex. Rabbit, Guinea Pig, Chinchilla, etc)
*
Breed?
*
If unknown, type unknown
Age?
*
Male/Female?
*
Please Select
Male
Female
Unknown
Spayed/Neutered?
*
Please Select
Yes
No
Unknown
If possible, please upload a photo of the pet here:
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How long have you owned this pet?
*
Where did you originally get this pet?
*
What is the reason you need to surrender this pet?
*
Where does the pet primarily live?
*
House (free roam)
Cage in home
Cage/Hutch outside
Basement
Garage
Other
How often is the pet outside of its cage/housing?
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Not at all
0-4 hours
4-8 hours
8+ hours
Other
How would you describe your pet? Check all that apply:
*
Social
Friendly
Active
Laidback
Playful
Shy
Independent
Fearful
Enjoys being picked up/held
Would rather not be picked up/held
Does the pet have any fears?
*
Does the pet have any favorite toys?
*
Is your pet accustomed to any of the following? Check all that apply:
*
Nail Clipping
Ear cleaning
Brushing/combing
Bathing
None of the above
Other
How would you best describe your household?
*
Active/Noisy
Quiet
Average
Other
Who lives in the home? Check all that apply:
*
Adult Women
Adult Men
Senior Citizens
Infants
Children aged 2-5 years
Children aged 6-9 years
Children aged 10-14 years
Teenagers 14+years
Dogs
Cats
Other
How would you best describe this pet's behavior around children?
This question is not mandatory, please skip if children do not live in the home.
If this pet is around other animals, how do they react?
This question is not mandatory. If this pet is not around other animals, skip to next question.
If applicable, is this pet litterbox trained?
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Yes
No
Not applicable
Other
What does the pet eat? Please be as detailed as possible.
*
What does this pet enjoy as treats?
How is this pet used to drinking water?
*
Water bottle on cage
Bowl in cage
Other
Has this pet ever bitten someone (a bite is defined as teeth breaking skin causing the person to bleed).
*
Yes
No
Unknown
If yes, please give as much detail as possible about the situation:
Has the pet ever been to a veterinarian?
Please Select
Yes
No
Does the pet have any medical/health issues? If yes, please give as much detail as possible:
*
Is there anything else you'd like us to know about this pet?
*
I understand that Rescue Village has a service area and that if I am outside of that service area, I may be directed to other agencies for assistance depending on the situation, shelter capacity, waiting list length, etc.
*
I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
I understand that Rescue Village requests an intake fee of $50 to assist with cost of care.
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I understand and can provide the full fee.
I understand, but am asking for a reduced or waived fee.
I understand that I MUST have an intake appointment and that Rescue Village does not accept walk-in surrenders.
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I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
I agree to check my email (including my junk/spam folder) regarding important communication from Rescue Village in regards to this surrender form.
*
I understand and will check my email AND junk/spam folder.
I do not have email and will require a phone call instead.
I understand that Rescue Village is NOT an open admission shelter, meaning not every application is able to be accepted. I understand that Rescue Village is a limited admission, unlimited stay humane society and that my application can be denied for any reason.
*
I understand
I do not understand and will seek other options. I understand that by selecting this option I will not be contacted.
I understand that if my application is accepted, I may be placed onto a waiting list as Rescue Village never euthanizes for space. I understand that this waiting list may be lengthy.
*
I understand
I am unable to wait and will seek out other options. I understand by selecting this option I will not be contacted.
Rescue Village reserves the right to decline surrender requests at its discretion. We kindly ask that all interactions with our staff remain respectful. Any use of inappropriate behavior may result in refusal of services.
Please Select
I agree
I do not agree and will seek other options
By signing below, I understand that Rescue Village has the right to deny my surrender form for any reason. I also understand that if my surrender form is accepted, there may be a lengthy wait because Rescue Village does NOT euthanize animals for time or space reasons and can only schedule in animals as species appropriate space allows.
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