Small Animal Surrender Form
Please fill out ONE form per animal you need to surrender.
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: intake@rescuevillage.org
*
example@example.com
Pet's Name (One pet per form please)
*
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 it's cage/housing?
*
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?
*
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?
*
Would you like to discuss resources that may be available to help you keep your pet?
*
Please Select
Yes
No
This is not an option for me
I understand that I MUST have an intake appointment and that Rescue Village does not accept walk-in surrenders.
*
I understand
I do not understand 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 cage space allows.
*
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