Small Animal and Reptile Owner Surrender Form

Owner Surrender Form

Rabbits, Guinea Pigs, Reptiles and other Small Animals
Your Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

CityState / Province

Postal / Zip Code
If we are unable to take in your pet, we will place your pet on a waiting list. If this is an urgent placement please call #610-970-7500 after completing the surrender form.

Diane’s Pet Supplies & Adoption Center has generously agreed to assist you in placing your pet in a new home. The terms of this agreement are as follows: Once the pet is surrendered to our rescue, you're giving up all rights to this pet. If for any reason Diane’s decides to no longer assist you in placing your pet, you will take the animal back into your possession within 24 hours of being notified.
Signature

Clear
What is this pet?

Guinea PigGerbilRabbitHamsterSnakeMouseRatLizardFerretOther
What breed is the pet?
What is the pet's name?
What is the pet's age?
Does your pet like people?

Loves EveryoneLikes WomenLikes ChildrenNot SocializedLikes MenOther
Does the pet have any medical or behavior concerns? if so please describe in detail.
Please tell potential adopters some great qualities about your pet and what the ideal home would be like.
Where did you acquire/adopt this pet from?
How long have you had this pet?
What is the reason you are surrendering your pet?
Please take a few good quality, well lit photographs of the pet and upload them below or email them to us at store@ddpets.com with your name and the animal's name in the subject of the email. If you have any videos of the pet please upload one below or send us the link to them on youtube.

photos
Cancelof
video upload

Cancelof
video link
Should be Empty: