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
Format: (000) 000-0000.
Animal Name
Species
Breed
Age/DOB
Spayed/Neutered
Weight and Size
Color/Markings
Why are you surrendering the animal?
How long have you had the animal?
Has the animal had previous owners?
General history of the animal?
Has the animal received veterinary care?
Please provide vaccine dates
Name of veterinary clinic
Phone number of veterinary clinic
Please enter a valid phone number.Format: (000) 000-0000.
Please list any known medical conditions
Has the animal been used for breeding purposes?
What does the animal eat ( brand of food) and frequency of meals?
Does the animal have any allergies (food/environment)?
Has the animal ever become aggressive over or around food or treats?
Does the animal have separation anxiety?
Where does the animal sleep at night?
Is the animal crate trained?
What is the animal's personality?
Does the animal have a bite history?
Has the animal ever bitten or attacked:

Other
If yes, please provide a detailed description of the bite history.
Please check all that apply. Is the animal good with the following:
If no, please explain the behaviour around animals, children, strangers, and visitors
Does the animal have destructive habits?
If yes, please describe the destructive habits.
What is the animal's energy level?
Is the animal house trained?
Is the animal leash trained?
Is the animal a flight risk?
Has the animal ever run away?
Where did you acquire the animal? (Breeder, shelter, found stray, friend, etc.):
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