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On-line Surrender Form

Home / On-line Surrender Form

Person Information

Name *

First

Last

Phone (Including area code) *

Email We use this email to contact you with questions about the information on your form and to schedule your appointment if your Pet is eligible for Intake. * *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Animal Information

The information requested in this section will help us determine if your pet is a candidate for our Adoption Program.

Reason for the Need to Surrender your Pet: *

Type of Pet * *

Dog (8+ Weeks of Age)
Cat (8+ Weeks of Age)
Other (8+ Weeks of Age)

Other Information

Help us get to know your Pet a little better. Please be as thorough as possible as this information will be used to determine if your Pet is a good fit for our program.

Pet's Name *

About how old is your Pet? *

How long have you had your Pet? *

Where did you get this Pet? *

If you adopted this Pet from a Person or Adoption Facility, have you contacted them? Many shelters/rescues will take any animals adopted from their organization. *

No
Yes
I did not get this pet from a Person or Adoption facility

Sex *

Male Neutered (Fixed)
Male Not Fixed
Female Spayed (Fixed)
Female Not Fixed

About how much does your Pet weigh? *

Is your Pet Microchipped? *

No
Yes
Not sure

Date of your Pet's last Vet Visit:

Is your Pet current on Vaccinations? *

No
Yes
Not sure

Are you able to provide recent vet records? *

No
Yes

Is your Pet primarily an Indoor Pet or an Outdoor Pet? *

Indoor
Outdoor
Half and Half

Does your Pet sleep Indoors? *

No
Yes

What Brand of Food is your Pet eating? *

Does your Pet eat Wet Food or Dry Food? *

Wet
Dry
Mixture

Is your Pet good with Children? *

No
Yes
Never exposed to children

Describe any interactions this Pet has had with Children. *

Is your Pet good with other Animals (dogs, cats, small mammals, farm animals)? *

No
Yes
Never exposed to other animals

Describe any interactions this Pet has had with other Animals. *

Is your Pet good with New People (Strangers)/New Situations? *

No
Yes

Describe how your Pet reacts to Strangers or New Situations. *

If your Pet is approved for Intake, but is not able to be handled safely by Staff upon Intake, acceptance into the Adoption Program will be denied at that point. Please initial here to acknowledge your understanding of this note. *

Has your Pet ever bitten anyone? *

No
Yes

Does your Pet have any Behavior Issues we may need to work on while they are in our care? Examples: Separation Anxiety, Mouthy, Jumpy, Shyness *

No
Yes

Is your Pet currently taking any medications or ever been prescribed any medications in the past? *

No
Yes

List any fun/interesting facts about your Pet that would help them find a new forever home.

Paragraph Text

Typing your name below will act as your signature in acknowledging that the information you have provided is truthful and that you understand the Acknowledgements listed above. * *

First

Last

Today's Date *

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