Pet Surrender Request
Cedar Bend Humane Society
Submitting this form does not guarantee immediate acceptance. We will review your request and contact you within 2-3 business days to discuss next steps. This process helps us ensure we can provide the best care for your pet and find them a suitable new home.
Owner Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you the legal owner of this animal?
*
Yes
No
If you are not the legal owner of this animal, what is your relationship to the animal, and do you have legal authority to surrender them?
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Pet Information
Pet's Name
*
Species
*
Please Select
Dog
Cat
Rabbit
Bird
Other
Breed/Mix
*
Age
*
Sex
*
Please Select
Female
Male
Weight (approximate)
Color/Markings
Microchip Status
*
Please Select
Yes, microchipped
No microchip
Unknown
Microchip Number
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Behavioral & Social Information
Positive Traits (Check all that apply)
House/Potty Trained
Good with Children
Good with Dogs
Good with Cats
Friendly/Social
Obedient/Well-Trained
Calm/Gentle
Playful/Active
Known Commands and Tricks
Behavioral Concerns (Check all that apply)
Shows Aggression
Anxious/Fearful
Destructive Behavior
Escapes/Runs Away
Excessive Barking/Noise
Not House/Litter Box Trained
Not Good With Other Animals
Has Bitten Another Animal or Person
Shows Preference/Aggression Toward Specific People
Please provide details about any behavioral concerns checked above
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Bite History
Legal Requirement: We MUST know if this animal has bitten and drawn blood on a person within the last 10 days.
Has this animal bitten and drawn blood on a person within the last 10 days?
*
Yes
No
N/A - Has never bitten
If your pet has EVER bitten another animal or person, please describe the circumstances.
Have you sought professional training or medical advice for any behavioral concerns?
Yes
No
Considering it
If yes, please describe what type of help was sought and the results
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Health Information
Veterinarian Name/Clinic
*
Last Veterinary Visit
-
Month
-
Day
Year
Date
Is your pet spayed/neutered?
*
Please Select
Yes
No
Unknown
If spayed/neutered, at what age?
Current on Vaccinations?
*
Yes, up to date
No/Overdue
Unknown
Do you give Cedar Bend Humane Society permission to contact your veterinarian for medical records?
*
Yes, you have permission
No, do not contact
Known Health Issues or Medical Conditions
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Surrender Details
Primary Reason for Surrender
*
Please Select
Moving/Housing Issues
Allergies
Financial Hardship
Not Enough Time
Behavioral Issues
Owner's Health Issues
Pet's Health Issues
New Baby
Problems with Other Pets
Death in Family
Other
Detailed Explanation
*
How urgent is this surrender?
*
Immediate (within days)
Soon (within 2 weeks)
Flexible timing
How long have you owned this pet?
*
Please Select
Less than 1 month
1 - 6 months
6 months - 1 year
1 - 3 years
3 - 5 years
More than 5 years
Where did you get this pet?
*
Please Select
Cedar Bend Humane Society
Other Animal Shelter
Rescue Organization
Breeder
Pet Store
Friend/Family
Found as Stray
Online/Craigslist
Other
If from Cedar Bend Humane Society, when did you adopt this pet?
-
Month
-
Day
Year
Date
If from shelter, rescue, or breeder (other than Cedar Bend) please provide contact information
Did you contact the shelter, rescue, or breeder where you got this pet about returning them?
*
Yes, I contacted them
No, I did not contact them
N/A - Did not get from shelter/rescue/breeder
If you contacted them, what was their response?
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CBHS Resources
We offer medical and behavioral assistance programs that may help you keep your pet. While there are fees associated, we may be able to provide guidance, training resources, or medical support options.
Would you be interested in keeping your pet if Cedar Bend Humane Society could provide resources to help address the issue?
*
Very interested - please contact me
Somewhat interested - would like to hear options
Not interested - surrender is necessary
If interested in assistance, please describe what type of help would be most beneficial
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Additional Information
Additional Comments
*
Preferred Contact Method
*
Phone Call
Email
Text Message
Submit Surrender Request
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