Small Animal Surrender Form

Small Animal Surrender Form

Please fill out ONE form per animal you need to surrender. NOTE: Filling out an application does not guarantee we will be able to accept the pet into our shelter. You will receive a reply to your application within 1-2 weeks to determine if we can place you on our admission waiting list.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County?*
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?*
Spayed/Neutered?*
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 homeCage/Hutch outsideBasementGarageOther
How often is the pet outside of it's cage/housing?*

Not at all0-4 hours4-8 hours8+ hoursOther
How would you describe your pet? Check all that apply:*

SocialFriendlyActiveLaidbackPlayfulShyIndependentFearfulEnjoys being picked up/heldWould 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 ClippingEar cleaningBrushing/combingBathingNone of the aboveOther
How would you best describe your household?*

Active/NoisyQuietAverageOther
Who lives in the home? Check all that apply:*

Adult WomenAdult MenSenior CitizensInfantsChildren aged 2-5 yearsChildren aged 6-9 yearsChildren aged 10-14 yearsTeenagers 14+yearsDogsCatsOther
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?*

YesNoNot applicableOther
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 cageBowl in cageOther
Has this pet ever bitten someone (a bite is defined as teeth breaking skin causing the person to bleed).*

YesNoUnknown
If yes, please give as much detail as possible about the situation:
Has the pet ever been to a veterinarian?
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 I MUST have an intake appointment and that Rescue Village does not accept walk-in surrenders.*

I understandI do not understand and will seek other options
I understand that Rescue Village requires an intake fee of $50 to help offset the cost of caring for this dog during it's time with us. Under certain circumstances, we can reduce or waive this fee, but it must be discussed with the Intake Manager prior to your intake appointment
I understand that Rescue Village is NOT an open admission shelter and that Rescue Village is a limited admission, unlimited stay humane society. I understand my application can be denied for any reason.
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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