Animal Surrender Form

Animal Surrender Form

Please fill in all sections of this form or your application be void.
Once you have received a reply from us, we expect a response within seven days otherwise we will remove you from the application process and you will have to resubmit the surrender form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number*
Email*
example@example.com
Please give details of the animal you wish to surrender
Name and Type of animal*
eg cat / dog
Specific breed (if any)*
eg british blue / corgi
Name of Animal*
Age of Animal*
Is the animal Male or Female?*
Is the animal Neutered or Unneutered*
Is the animal Microchipped?*
Please confirm microchip number.
Is the animal up to date with vaccinations?*
This means within the last 12 months.
If vaccinated, what date was the last vaccinations?*

MonthDayYear
Date
Vet details (name and address)*
We ask for a vet history for all cats. Can you provide this?*
Please get in touch with your vets to email it to us. Catteam.animalsamaritans@gmail.com
Please confirm any known medical issues. Please write 'NONE' if you answered no to the previous question*
Is the animal used to / comfortable in the company of other cats?*
Is the animal used to / comfortable in the company of dogs?*
Is the animal used to / comfortable in the company of children?*
Is the animal used to a garden or has it been an 'indoor' pet only?*
We do not provide a collection service. If you secure a rescue space you will be offered an appointment at one of our vets in DA7/DA11/ME16 to surrender your animal. Please confirm you understand this is the surrender process*
Detailed reason for surrendering the animal*
eg moving home / owner died etc
If you are not the registered owner you will need to confirm your relationship to owner and if you have authority to surrender the animal.
I confirm that all information on this form is true and complete. I confirm that by selecting YES, this will act as a confirmation signature.*
Once you have received a reply from us, we expect a response within seven days otherwise we will remove you from the application process and you will have to resubmit the surrender form
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