Surrender Form

Registration Form

Please fill in the form below.
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Animal Type:
Animal Sex:
Animal Name:
Animal's Age:
Animal Color:
Please Explain Why You Are Surrendering this Pet:
Has this pet ever bitten anyone?
Does your Pet have any behaviors that we should be aware of? (If yes explain below)
Behaviors:
Is your pet Crate Trained?
Is your Pet House trained?
Does your pet get along with dogs?
Does your pet get along with cats?
Does your pet get along with children?
Does your pet have current rabies vaccinations?
Does your pet have current core vaccines?
Is your pet Micro chipped? (If yes, please document below)
Micro Chip Info:
I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Animal Surrender Form, hereinafter referred to as “the animal.” I hereby surrender any and all property rights to the animal. I certify that no other person has a right of property to the animal. I understand that by surrendering my property rights to the animal, the animal may be transferred into the custody of an animal shelter. I also hereby certify that the animal has/has not bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and understand the terms of this Animal Surrender Form.
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Signature

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Registration Form