Animal Surrender Form (1) (1)

Name

Phone Number

Email Address

example@example.com

Address

City State and Zip Code

Name of animal being surrendered

Animal Age

Animal Gender

AlteredUnaltered

Breed

Primary Color

I have to give up my animal because

Where did you obtain this animal

I would describe my household as noisy quiet or active

My animal lived with the following people. Please include gender and

My animal lived with the following people Please include gender and age

My animal lived with the following animals Please include gender alteredunaltered status age and breed

Has the animal shown any negative behavior EVER Biting Growling Food Aggression Toy Aggression Gender Aggression Animal Aggression Incident during handling etc

If the animal has ever bitten a person or had any incidents resulting in severe injury please describe what happened in detail

If the animal has ever bitten another animal or had any incidents resulting in severe injury please describe what happened in detail

Is this animal kennel trained YesNo

How is the animal when left alone

Does the animal behave in a different manner during certain events Going to the vet fireworks thunder car rides strangers crowds being around other animals etc

What type of food were you feeding the animal

How often was the animal fed

My animal does NOT like to be touched in these places

How does the animal react when being seen by a veterinarian

List any health problems the animal has

Is the animal microchipped

Is the animal on any kind of medication If yes list the medication

When was the animal last seen by a licensed veterinarian

Name of veterinarian

Phone Number of veterinarian

Address of veterinarian

Has your animal ever escaped your yard If yes how many times

Is the animal house trained

Did the animal live inside or outside

Does the animal know any commands

What else do you want us to know about this animal

Is there anything you think we should know about this animal?

I hereby certify that I am the rightful owner, keeper, and caretaker, of the animal who is the subject of this Animal Surrender Form, hereinafter referred to as "the animal." I hereby surrender any and all property rights to the animal. I certify that no other person has a right of property to the animal. I understand that by surrendering my property rights to the animal, the animal is transferred into the custody of Ray of Light Rescue. I also hereby certify that the animal has not bitten, scratched

or harmed a human or another animal within the past 10 days. I understand that once I relinquish the animal to Ray of Light Rescue, the animal will not be available to be returned and that I will no longer have any rights over the animal once I have signed the Animal Surrender Form.I understand there is a nonrefundable surrendering fee of $50.00. I further certify that I have read and understand the terms of this Animal Surrender Form.

Printed Name

Signature

Date