Pet Surrender Application Form

Pet Surrender Application Form

Provide your details, the pet’s information, and your surrender reason, then sign to authorize the transfer.
Owner / Guardian Information
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Street Address, City, State, Zip, Country

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you the legal owner of the pet?
If not, what is your relationship to the pet/owner?
Pet Identification & Basic Details
Pet Name
Species
Breed / Mix
Primary Color / Markings
Age or Estimated Date of Birth
Gender
Spayed / Neutered Status
Microchipped Status
Microchip Number
How Long Have You Owned / Cared for This Pet?
Where Was the Pet Originally Obtained?
Reason for Surrender
Primary reason for surrender

Other
Steps taken to address or resolve the issue
Veterinary & Health History
Current Veterinary Clinic Name
Clinic Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Account Name at Clinic
Vaccination Status
Currently on Heartworm/Flea Prevention?
Known Medical Conditions, Allergies, Medications, and Special Diet
Behavioral Profile & Home Routine
Where does the pet sleep at night?
Housebroken or litter box trained?
Crate trained?
Reaction when left alone
Reactions toward known adults
Reactions toward strangers
Reactions toward children
If tested with children, what age group?
Reactions toward dogs
Reactions toward cats
Has the pet ever bitten a person or another animal?
If yes, describe the circumstances and date of the bite incident(s)
Does the pet exhibit resource guarding?
If yes, describe the resource guarding behavior
Legal Relinquishment & Authorization

By signing below, I certify and agree to the following:Ownership & Authority: I am the legal owner (or authorized agent) of the pet described above and have full authority to surrender this animal.Permanent Transfer: I permanently transfer all legal rights, ownership, and custody of this pet to Twin Titans Inc. I understand that this surrender is final and irrevocable.Accuracy of Information: To the best of my knowledge, all information provided in this form is true, correct, and complete—including any known bite history or behavioral concerns.Veterinary Records Release: I authorize Twin Titans Inc to contact my veterinary clinic and request complete medical records for this pet.
Date

MonthDayYear
Date
Sign
Should be Empty:

Pet Surrender Application Form

Owner / Guardian Information

Pet Identification & Basic Details

Reason for Surrender

Veterinary & Health History

Behavioral Profile & Home Routine

Legal Relinquishment & Authorization