P4P Surrender Form

Surrender

There are times when an owner can no longer care for their pet, or when a stray/abandoned pet is found. This form contains the necessary information we need to determine if we can assist with the re-homing of a pet. Although we would love to help all pets, we need to assess our current foster home situation along with other factors before making a decision. Filling out our pet surrender/return application does not guarantee that we will be able to rehome your pet.

About Your Pet
Species *
Gender *
Pet's Name
How long have you had this pet?
Has this animal ever snapped or bit someone? *

Yes No
Pet's Age *
Pet's Weight (approx.)
Breed *
Color
Where did you originally get this pet?
Pet has been kept... *
Does your pet get along with other: *

Dogs Cats Children Chicken/small animal Unknown
Why are you surrendering and what can you tell us about your pet? *
Please be as descriptive as possible. The more information provided, the better chance we have at finding a suitable home for this pet.

Medical History
Please list your veterinarian. *
Vet's Phone Number

Area Code Phone Number
Which vaccinations have been given to your pet?

Rabies Bordatella DHPP/DHLPP
Has your pet had a heartworm test?
Has your pet been spayed or neutered?
Does your pet have any history of medical concerns or behavioral issues?
Please upload a photo(s) of your pet

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Please upload all medical paperwork that you have for your pet.

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Acknowledgement & Signature
I hereby voluntarily and irrevocably give, donate, surrender and release this animal to Passport for Paws. I represent and warrant that I am the lawful owner of the Animal, and I have full power and authority to surrender the Animal to this rescue. No other person has any legal or equitable ownership interest in the Animal.

I have disclosed to Passport for Paws all material information regarding the medical and behavioral history of the Animal. I willfully surrender all medical records and information pertaining to the Animal. The rescue has my permission to contact my veterinarian for any necessary information pertaining to my Animal, and I hereby consent to the release of any and all medical information by any medical provider.
Today's Date

Month Day Year
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Your Signature *

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