Surrender Appointment Request

Surrender Request Form

Need to give up your pet? Fill out this form to request a surrender appointment. Please be honest and give as much detail as possible when answering questions about your pet’s history.
About You

This section is about you as the guardian of the pet
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
About Your Pet

This is section is about the pet you'd like to give up
Species*

CatDogOther
Spay / Neuter Status*

Female (Fixed)Female (Unfixed / Unknown)Male (Fixed)Male (Unfixed / Unknown)
Breed (if known)
Age*
Where did you get your pet?*

Humane Society of St. Lucie CountyHumane Society of Treasure CoastFort Pierce Animal Adoption CenterAnother Rescue or ShelterBreeder / Pet StoreFriend or Family Member
Select the reason for surrender*

Moving / change in housingCan't afford pet food or other necessitiesNo time / Can't fulfill needs due to timeCan't afford surgery, medicine, or euthanasia for petAggression towards humans or other animalsTrouble with training / frequent or inappropriate urinationThis is a stray animal I picked up / found recentlyOther / Reason not listed (see question below)
If the reason for surrender is not listed above, tell us more here:
Has this animal ever bitten or injured a person or another animal in the past?*

YesYes, recorded with local animal control or law enforcementNo, not to my knowledge
If you answered "yes" to the previous question, did the injury require medical attention or result in death?

YesNoUncertain
Please agree to the following:*

I have filled out the information truthfully and to the best of my knowledge.
Should be Empty:

Surrender Request Form

About You

About Your Pet