BAHS surrender request form

Surrender request form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Phone Number*
Was this pet adopted from BAHS?*

YesNo
Where did you get this pet from?*
Have you ever received or do you currently receive assistance from any of the following BAHS programs?*

Pet food pantrySpay/neuter voucherSafepetsVaccine clinicN/A
What is your pets name?*
What type of pet are you needing to surrender?*

DogCatLitter of kittensLitter of puppies
Why are you needing to surrender this pet?*
How old is your pet? *
Please specify years and/or months
What breed(s) is this animal?*
Is your pet spayed or neutered?*

YesNoUnknown
How much does the pet weigh?*

1-25lbs25-55lbs55-100lbsOver 100lbs
When and where was this pet last vaccinated?
Does your pet have any past or present medical conditions or concerns? (special /prescription diets, medications, past injuries, etc)*
Has this pet ever bit another person or animal?*

Yes, both people and animalsYes, bite history with peopleYes, bite history with another animalNo bite history
Please explain the circumstances surrounding the bite.
How long has this pet been in your care?*
This pet has lived with (check all that apply)*

DogsCatsKidsWomenMenOther animals
What is your pets reaction towards strangers?*
What is your pets reaction towards dogs?*
What is your pets reaction towards cats?*
Do you have any behavior concerns about your pet?*

YesNo
Please explain any behavior concerns
If a cat, do they have accidents outside of the litterbox?*

YesNoSometimesNot a cat
Has this pet bitten and broken the skin of anyone in the last 10 days?*

YesNo
Please upload a current photo(s) of the pet you're needing to surrender

Requests without photos will automatically be declined.
Cancelof
Is there anything else you feel we should know?
By signing below, I certify that I am the rightful owner of the described animal and that all provided information is accurate to the best of my knowledge.

I understand that submitting this form does not guarantee that BAHS will have the capacity to accept my animal into their care, and they reserve the right to deny my request. This request is considered valid for 30 days.

BAHS will be in contact with you via email or phone within 7 days of submitting this request. Be sure to check your spam folder.
Date of Signature*

MonthDayYear
Date
Signature*

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Surrender request form