Owner Surrender Request

Owner Surrender Request

The Michael Movement 501(c)3 Nonprofit | Completion of this form does not guarantee we can take ownership of your animal
Contact Information
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Today's Date

MonthDayYear
Date
Animal Information
Name
Species/Breed
Sex
Age
Health Conditions?
Current on Vaccinations?
Who is your pet's current Vet?
Is your pet on any medications? If yes, what medications?
Please provide vaccinations/ medical records:

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Is your pet microchipped? If yes, what is microchip number?
Spayed/neutered?
Allergies:
Reason for Surrender
Any health or behavior concerns we should be aware of?
Behavioral or training records (if available)

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Does this animal have a bite history?
Has your pet ever bitten a person?
Has your pet ever bitten another animal?
If yes, please describe each incident.
Has medical treatment ever been required after a bite?
Has animal control ever been involved?
Has your pet ever snapped, growled, lunged, or shown warning signs toward people?
How long have you owned this animal?
Do you need assistance in order to keep this animal?
Where did this animal come from?
Is there a deadline for rehoming?
How would you describe your pet's personality?
What does your pet enjoy most?
What motivates your pet? (food, toys, praise, etc.)
What challenges does your pet have?
What are your pets strengths?
Where does the pet spend most of its time?
Is the pet house trained?
is your pet crate trained?
Has the pet ever escaped a yard or home?
What is the pet's daily routine?
What commands does the aminal know?
Has the pet attended any training classes?
Is the pet leash trained?
Does the pet have reliable recall?
Has the pet lived with other dogs?
Does the pet enjoy playing with other dogs?
Has the pet lived with cats?
How does the dog react to cats?
Any history of fights or injuries involving other pets/animals?
Does the pet guard food, toys, beds, or people from other pets?
Any prey drive toward small animals?
Has the pet lived with livestock or other pets?
Has the pet lived with children? If yes, what ages?
How does the pet react to strangers?
How does the pet react to visitors entering the home?
Any concerns around handling, grooming, or veterinary care?
What type of home would be best for your pet?
What type of home would NOT be a good fit?
Is there anything else you'd like potential adopters to know?
What is the most difficult thing about living with this pet?
If surrender is not immediately necessary, would you be interested in receiving resources or support that may help you keep your pet?
Training resources, Temporary food assistance, Medical assistance resources, Behavioral support, Rehoming assistance only.
Are you willing and able to continue caring for your pet while we search for an appropriate adoptive home?
If Maybe, Explain:
If yes, how long are you able to continue caring for your pet while they are listed for adoption?
Would you be willing to participate in meet-and-greets with potential adopters?
Upload Photos of pet:

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Release of animal acknowledgement

I hereby request to relinquish and release the above mentioned animal from my ownership and to grant ownership to The Michael Movement. Receipt of this application does not guarantee ownership will be transferred. I will be contacted for more information if The Michael Movement can take possession of my animal.
Signature
Should be Empty:

Owner Surrender Request

Contact Information

Animal Information

Release of animal acknowledgement