slr_Owner Surrender

Owner Information

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Cell Phone Number

Area CodePhone Number

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How did you hear about us?

Would you be willing to speak with a trainer to try and fix this situation so you could keep your pet?

Trainers generously donate their time and expertise for these calls. The surrender form must still be completed, but please check the “Yes, I’d like to speak with a trainer” box below

Would you like to speak to a trainer/specialist?*

YesNo

Are you able to provide a monetary donation upon surrender of your pet and/or provide monthly monetary donations while your pet is in our care? Please provide details:

Upload an image of your pet

Browse Files

JPG, PNG

Pet's Information

Pet's Name*

Sex of Pet*

Is the Pet Neutered/Spayed?*

YesNo

Is the Pet Microchipped?*

YesNo

If yes, please provide the number

Pet's Breed*

Pet's Age*

Pet's Weight

Where did you get your pet?

How long have you had your pet?

Please describe the reason you need to surrender your pet?*

Has your pet lived with dogs, cats, children? Please list and include gender and ages:

Does your pet show aggression towards adults, children, dogs, cats? Please list:

Does you pet have any behavioral issues? Please describe:

If applying to surrender a dog, please complete this section:

Has your dog been tested for heartworm in the past year?

YesNoUnsure

Is your dog up to date on vaccines?

Rabies

YesNoUnsure

Distemper/Parvo

YesNoUnsure

Bordetella

YesNoUnsure

Lepto

YesNoUnsure

If you answered No or Unsure to any of the above, are you willing to provide the needed vaccinations/testing if your pet is accepted for residency at Satchel's?

YesNo

Please describe any existing medical conditions:

What is the date of your pet's last vet visit?

Date

May we contact your vet to verify the information you have provided?

YesNo

If Yes to above question, please provide vet's name and phone number:

Is your dog friendly when visitors come to your home?

YesNo

How does your dog react when you pet them or approach them while eating, playing with a toy, or chewing on a treat?

If applying to surrender a cat, please complete this section:

Has your cat been tested for FIV and Feline Leukemia in the past year?

YesNo

Is your cat up to date on vaccines?

FVRCP for cats?

YesNoUnsure

FeLV for cats?

YesNoUnsure

Rabies?

YesNoUnsure

Please describe any existing medical conditions:

What is the date of your pet's last vet visit?

Date

May we contact your vet to verify the information you have provided?

YesNo

If Yes to above question, please provide vet's name and phone number:

Does your cat ever urinate or defecate outside the litter box?

YesNo

If yes to the above question, please explain:

I understand that submission of this application is a request on my pet’s behalf to be considered to be placed on Satchel’s Last Resort Animal Shelter/Sanctuary’s waitlist and does not constitute an acceptance of residency by Satchel’s Last Resort Animal Shelter/Sanctuary. We encourage you to continue to seek placement elsewhere.

How long are you able to keep the pet in your home while searching for placement? *

By submitting this application, I hereby acknowledge that I am the lawful owner of the animal I am seeking to surrender and I came into possession of this animal legally.