Dog Surrender Form

Name:*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Date:*

Date

Animals Name:*

Age

Breed*

Upload a picture of your dog.*

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Check the corresponding boxes to inform Charlotte Sheltered Souls Animal Rescue as to whether or not your pet has any behavioral concerns worth noting or working on with a professional trainer while in foster. Any items marked Yes will be worked on with a trainer. Any items marked Maybe will be evaluated.

YesNoUnknown

Yes (provide detail)NoUnknown

YesNoUnknown

YesNoUknown

YesNoUnknown

Yes (explain)NoUnknown

Notes/Reason for Surrender*

We are a small grassroots 501c3 Animal Rescue in Charlotte, NC.

Our mission is to help pets deemed 'undesirable' and 'unworthy' by the public and get them adopted into loving homes.

We have a pet food bank to support those facing financial hardships. If you need food for your pets, please fill out our pet food bank form. We always prefer to keep pets with their owners over having them surrendered to us.
At times, we may help out with medical expenses for pets but that is all dependent on the donations we receive and is never guarateed.
If you are in need of end-of-life services for your beloved pet, we will help you find resources available to you.

*We evaluate surrenders on a case-by-case basis.*

*At this time, we are unable to take any pets with serious medical issues (i.e heartworm disease, positive for parvo, distemper, ringworm, etc)*

We prioritize areas and regions where animal shelters are overrun with animals and need rescues to step up in order to eleveate resources. This means that we will only be taking owner surrenders from North Carolina, South Carolina, and on rare occasions, Georgia.

If you are outside of these states, we will try to find rescues to connect you with in your area that may be able to help you.

If you have any questions, please reach out to us at cltshelteredsoulsanimalrescue@gmail.com for more information.

I hereby give Charlotte Sheltered Souls Animal Rescue permission to request all medical history and medical records from my Veterinarian(s) for the animal I am relinquishing.I acknowledge that my signature on this receipt relinquishes all claims of ownership of the animal(s) described. Neither my family, any representatives acting on my behalf, nor I may assert present and/or future claims, suites, or otherwise against Charlotte Sheltered Souls Animal Rescue with respect to this animal(s). I understand that the Charlotte Sheltered Souls Animal Rescue will not return this animal to me, once left in its care, under any circumstances, unless otherwise approved by the founder(s) or members of Charlotte Sheltered Souls Animal Rescue.

Signature*

Upload a photo of your ID showing proof of residency in North Carolina, South Carolina, or Georgia*

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