INTAKE FORM

SURRENDER REQUEST

Thank you for reaching out to us. One of our dedicated volunteers will review your submission and contact you as soon as possible to discuss the next steps. Please note that while we do everything we can to assist animals in need, rescues are maxed out, and we cannot guarantee immediate placement for your animal. Our ability to take in animals depends on the availability of suitable foster homes and resources. We are committed to finding the best outcome for every animal, and we appreciate your understanding and patience as we work through this process.
Your Name:

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Animal’s name, species (dog, cat, other) breed (if known) Age/DOB (if known)sex. Is the animal spayed/neutered? Weight/Size, Color/Markings:
Why are you surrendering/fostering this animal? How long have you had the animal? (if applicable) Where was the animal found? (if applicable) Do you know the animal's prior history (if not the original owner)?
Has the animal seen a veterinarian? If yes, provide: Vet Clinic Name: Date of last visit: Vaccination Records (distemper, rabies, etc.): Known medical conditions or special needs: Is the animal currently on any medications? If yes, list them:
Describe the animal’s personality (friendly, shy, independent, etc.): Is the animal good with other animals (dogs, cats)?Children? (If yes, what ages?) Strangers or visitors? Does the animal show any fearful or aggressive behaviors (growling, snapping, cowering)? Is the animal housetrained or litterbox trained? Does the animal have any destructive habits (chewing furniture, scratching, digging)? How does the animal behave during grooming, nail trims, or vet visits?
What does the animal typically eat? (Brand, quantity, frequency): Does the animal have any food allergies or dietary restrictions? Where does the animal sleep at night (crate, bed, outside)? How much exercise does the animal typically get daily? Does the animal have any favorite toys or activities?
Where did you acquire the animal? (Breeder, shelter, found stray, friend, etc.): Has the animal ever been lost or gone missing? Has the animal ever bitten or injured anyone or another animal? If yes, please explain. Has the animal been used for breeding purposes?
What is your biggest concern for this animal? What would you want a potential adopter to know about this animal? Are you willing to provide additional information or assist with transitioning the animal into rescue care?
Please add photos of your pet here:

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Legally Binding Acknowledgment:P PLEASE READ CAREFULLY EXCLUSION OF LIABILITY – ASSUMPTION OF RISK The Applicant agrees that he/she relinquishes all claims and rights to this pet and gives full ownership of this pet to Myrtle Animal Rescue & Sanctuary, and the pet becomes the property of Myrtle Animal Rescue & Sanctuary.The Applicant hereby releases and forever discharges Myrtle Animal Rescue & Sanctuary from any and all causes of action, claims, or demands which the Applicant has, or hereinafter may have against Myrtle Animal Rescue & Sanctuary.In the event that the Applicant should make any claim or demand or commence or threaten to commence any action, claim, or proceeding against Myrtle Animal Rescue & Sanctuary, this document may be raised as an estoppel and complete bar to any such claim, demand, action, proceeding, or complaint.The Applicant agrees not to make a claim or take proceedings against any other individual, association, person, or corporation who might claim contribution or indemnity under the provisions of any common law or Statute of Canada or Statute of Ontario.The Applicant agrees that he/she has read this document in full and understands that it contains a full and final release of any claim which he/she has, or may have, against Myrtle Animal Rescue & Sanctuary.

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SURRENDER REQUEST