• Image field 308

  • Surrender Request Form

    If you need to surrender a dog or cat to CHA Animal Shelter, please answer all questions in this form honestly and completely. A staff member will then reach out through email to discuss your animal(s) and see how and when CHA can best help you.
  •  / /
  • Format: (000) 000-0000.

  • I need to surrender * cat(s) AND/OR * dog(s).

  • I need to surrender a litter of 2 or more kittens (under 4 months of age) that DO NOT have a mother cat with them.*
  • Are the kittens spayed/neutered?

  • Please list the names and descriptions of each kitten:

    Name:
    Description:
    Name:
    Description:
    Name:
    Description:
    Name:
    Description:
    Name:
    Description:
    Name:
    Description:
    Name:
    Description:
    Name:
    Description:

  • Are the kittens generally good with (select all that apply):
  • Are the kittens generally NOT good with (select all that apply):
  • Have the kittens ever been around children?
  • Describe the general personalities of the kittens (select all that apply):
  • What type(s) of food do the kittens eat (select all that apply)?
  • Have any of the kittens ever (select all that apply):
  • Did the incident break the skin on a human?
  • Do any of the kittens have any past or current medical concerns or conditions?
  • Have the kittens received veterinary care?
  • Are the kittens pooping and peeing on their own?
  • Can the kittens be easily caught, picked up, and carried?

  • Optional

  • Animal Information

  • If surrendering a mother cat or dog AND her litter, fill out this section with the mother's information.

    There is a section at the bottom of this page where information about individual puppies or kittens can be written.

  • The animal is:*
  • Weight*
  • Is the animal spayed/neutered?*
  • Where did you get the animal?*
  • Is the animal good with (select all that apply):*
  • Is the animal NOT good with (select all that apply):*
  • The animal has lived with (select all that apply):*
  • Has the animal ever been around children?*
  • Describe the animal's personality (check all that apply):*
  • Does the animal have separation anxiety?*
  • Does the animal have any past or current medical concerns or conditions?*
  • Has the pet ever (select all that apply):*
  • Did the incident break the skin on a human?
  • This animal is a:
  • Is the dog housebroken?
  • Can the dog be housed for a prolonged time in a cage?
  • Describe how the dog does on walks/on leash (select all that apply):

  • Optional:

  • Is this cat litter-trained?
  • Does the cat ever spray or mark outside the box?
  • How did you resolve this issue (select all that apply):
  • Can the cat easily be caught, picked up, and carried?

  • Optional:

  • Are you in need of surrendering another animal?*

  • Animal Information

  • The animal is:
  • Weight
  • Is the animal spayed/neutered?
  • Where did you get the animal?
  • Is the animal good with (select all that apply):
  • Is the animal NOT good with (select all that apply):
  • The animal has lived with (select all that apply):
  • Has the animal ever been around children?
  • Describe the animal's personality (check all that apply):
  • Does the animal have separation anxiety?
  • Does the animal have any past or current medical concerns or conditions?
  • Has the pet ever (select all that apply):
  • Did the incident break skin on a human?
  • This animal is a:
  • Is the dog housebroken?
  • Can the dog be housed for a prolonged time in a cage?
  • Describe how the dog does on walks/on leash (select all that apply):

  • Optional:

  • Is this cat litter-trained?
  • Does the cat ever spray or mark outside the box?
  • How did you resolve this issue (select all that apply):
  • Can the cat easily be caught, picked up, and carried?

  • Optional:

  • Do you have a third animal to surrender?

  • Animal Information

  • The animal is:
  • Weight
  • Is the animal spayed/neutered?
  • Where did you get the animal?
  • Is the animal good with (select all that apply):
  • Is the animal NOT good with (select all that apply):
  • The animal has lived with (select all that apply):
  • Has the animal ever been around children?
  • Describe the animal's personality (check all that apply):
  • Does the animal have separation anxiety?
  • Does the animal have any past or current medical concerns/conditions?
  • Has the pet ever (select all that apply):
  • Did the incident break the skin on a human?
  • This animal is a:
  • Is the dog housebroken?
  • Can the dog be housed for a prolonged time in a cage?
  • Describe how the dog does on walks/on leash (select all that apply):

  • Optional:

  • Is this cat litter-trained?
  • Does the cat ever spray or mark outside the box?
  • How did you resolve this issue (select all that apply):
  • Can the cat easily be caught, picked up, and carried?

  • Optional:

  • Do you have a fourth animal to surrender?
  • The animal is:
  • Weight
  • Is the animal spayed/neutered?
  • Where did you get the animal?
  • Is the animal good with (select all that apply):
  • Is the animal NOT good with (select all that apply):
  • The animal has lived with (select all that apply):
  • Has the animal ever been around children?
  • Describe the animal's personality (select all that apply):
  • Does the animal have separation anxiety?
  • Does the animal have any past or current medical concerns/conditions?
  • Has the pet ever (select all that apply):
  • Did the incident break the skin on a human?
  • This animal is a:
  • Is the dog housebroken?
  • Can the dog be housed for a prolonged time in a cage?
  • Describe how the dog does on walks/on leash (select all that apply):

  • Optional:

  • Is this cat litter-trained?
  • Does the cat ever spray or mark outside the box?
  • How did you resolve this issue (select all that apply):
  • Can the cat easily be caught, picked up, and carried?

  • Optional:

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Surrender Contract

    NOTE: You will be required to read and sign the below portion of the surrender form at the time of your surrender appointment. The wording of this section is included for your convenience.

  • Please accept my surrender fee of $40.00.

    I'd like to donate an additional amount to help care for this animal $___.

    Total I would like to donate today is $___.

    I understand that if I am unable to pay the surrender fee, CHA Animal Shelter may not be able to take the pet(s) I have brought today.

    ___ By checking this box, I certify that I am financially unable to pay a surrender fee.

    I hereby release, unconditionally, the animal described above, to CHA Animal Shelter. I understand that by relinquishing ownership rights of this animal, I will not be able to determine its final disposition. I understand that this animal will either be placed up for adoption or humanely euthanized.

    ___ By checking this box, I am stating that I want to be contacted in the event that my surrendered animal(s) cannot be placed on the adoption floor as I would like to redeem the animal(s). I understand that this does not guarantee I will be contacted.

    I also understand that if I seek to reclaim this animal, I will go through the regular CHA Adoption procedures.

    I also affirm that I have not taken this animal from another person without that person’s consent.

  • Should be Empty: