Animal Surrender Form

Name

First NameLast Name

Phone

Email

Example: email@gmail.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

When do you need to surrender the animal?

Are you able to meet or drop off the animal?

Animal species

Sex

Age

Is the animal

Is the animal sick or injured?

If yes, please describe illness or injury to the best of your ability.

Will the animal come with enclosure/supplies? ( not a requirement) if yes, please describe what is coming with the animal.

Why are you surrendering the animal?

Please leave behavior & temperament answers here

Does the animal have any past or present health problems?

If yes, please describe

Is the animal currently taking any medication?

If yes, please list medications

What is the animal eating ?

How often is the animal fed?

Please feel free to tell us any other information about the animal you feel is important.

Please upload a picture of the animal

Please upload any records you have for the animal

I hereby certify that this animal is my animal, and I have full authority to surrender it.

If it is not my animal, it is an animal I found abandoned, lost, released or something along those lines ( please list in the above )

I understand that surrendering this animal relinquishes my ownership of the animal and I no longer have any rights to the animal.

I certify and understand that surrendering the animal means I will not be getting the ownership of the animal back, or getting any type of financial gain from the animal.

I certify that all information is true and accurate to the best of my knowledge.

Signature

Animal Surrender Form

ANIMAL & HOUSEHOLD INFORMATION

How is the animals temperament / behavior?

FEEDING

OTHER