Leashes of Love Rescue Owner Surrender Form

Leashes of Love Rescue Owner Surrender Form
Name of animal you are surrendering*
Why are you surrendering this animal?*
How long have you had the animal?*
Animal's age*
Description/breed of animal*
Animal's sex*

FemaleMale
Is your animal up to date on vaccines?*

YesNo
Has the animal been spayed/neutered?*

YesNo
Has the animal been microchipped?*

YesNo
Microchip number *
Do you take your animal to a veterinarian?*

YesNo
Name of animal's veterinarian
Veterinarian's address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Veterinarian's phone number

Area CodePhone Number
Do you have the vet records of this animal? If so, please provide us with a copy*

YesNo
Upload vet records here.

Browse Files

Cancelof
Has the animal lived with (check all that apply)*

ChildrenCatsDogsLivestockMenWomen
Does the animal like (check all that apply)*

ChildrenCatsDogsLivestockStrangersMenWomen
Has the animal ever bitten anyone? *

YesNo
If yes, please explain the circumstances that caused the animal to bite. *
If the animal has bitten, was it reported?*

YesNoN/A
What would you change about the animal’s behavior?*
Describe the animal’s personality (check all that apply) *

ShyAggressiveFriendlyProtectiveHyperactiveResource guardingLeash issues
Is the animal house/potty trained?*

YesNo
Is the animal crate trained?*

YesNo
Where does the animal stay during the day? *

InsideOutside
Where does the animal stay at night?*

InsideOutside
Did the animal live: *

InsideOutsideBoth
In the last 2 weeks, has the animal shown signs of sickness?*

YesNo
If yes, please explain.*
Is this animal on any medication?*

YesNo
If yes, please provide medication names. *
Please give us any additional information you can to help find your pet the right new home. (Allergies? Medical issues? Surgeries?, etc.)
Owner's full name*

First NameLast Name
Owner's email*
Owner's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Owner's phone number*

Area CodePhone Number
Owner's work number*

Area CodePhone Number
IMPORTANT! Please read the following:

All of the information I have provided is true and complete to the best of my knowledge.

If Leashes of Love Rescue, Inc. determines your animal is unadoptable, with permission, we will contact you and give you 24 hours to respond.

I hereby release the animal described above with all rights, title and interest of ownership to the custody of Leashes of Love Rescue, Inc. I declare that I obtained the animal legally, and that I waive all future rights in the ownership or control of the animal described above. I agree to hold Leashes of Love Rescue, Inc.’s employees exempt from liability or blame.

I VOLUNTARILY SIGN BELOW TO EVIDENCE MY ACCEPTANCE OF THE ABOVE PROVISIONS.

By typing your name at the bottom of this release, it is considered and electronic signature and therefore binding.
I agree to the terms as stated above.*

AgreeDisagree
Please type your name*
Please enter today's date.*

MonthDayYear
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