Animal Surrender Form

Name of Animal Being Surrendered:
Age of Animal
Sex	Male Female
Species	Cat Dog Other
Breed	Abyssinian Affenpinscher Afghan Hound African Grey Airedale Terrier Akbash Akita Alaskan Malamute Amazon American American Bulldog American Curl American Eskimo Dog American Fuzzy Lop American Sable American Shorthair American Staffordshire Terrier American Water Spaniel American Wirehair Anatolian Shepherd Angora Rabbit Appaloosa Appenzell Mountain Dog Applehead Siamese Arabian Australian Cattle Dog/Blue Heeler Australian Kelpie Australian Shepherd Australian Terrier Balinese Basenji Basset Hound Beagle Beagle/Hound/Pit Bearded Collie Beauceron Bedlington Terrier Belgian Hare Belgian Shepherd Dog Sheepdog Belgian Shepherd Laekenois Belgian Shepherd Malinois Belgian Shepherd Tervuren Bengal Bernese Mountain Dog Beveren Bichon Frise Birman Black and Tan Coonhound Black Labrador Retriever Black Mouth Cur Bloodhound Bluetick Coonhound Bobtail Bombay Border Collie Border Terrier Borzoi Boston Terrier Bouvier des Flanders Boxer Boykin Spaniel Briard Britannia Petite British Shorthair Brittany Spaniel Brotogeris Brussels Griffon Budgie/Budgerigar Bullmastiff Bull Terrier Bully / Lab Mix Bully Mix Bunny Rabbit Burmese Burmilla Caique Cairn Terrier Calico Californian Canaan Dog Canadian Hairless Canary Cane Corso Mastiff Carolina Dog Catahoula Leopard Dog Cattle Dog Cavalier King Charles Spaniel Champagne D'Argent Chartreux Checkered Giant Chesapeake Bay Retriever Chicken Chihuahua Chinchilla Chinchilla Chinchilla Chinese Crested Dog Chinese Foo Dog Chocolate Labrador Retriever Chow Chow Cinnamon Clumber Spaniel Clydesdale Cockapoo Cockatiel Cockatoo Cocker Spaniel Collie Conure Coonhound Coon Hound Corgi Cornish Rex Coton de Tulear Cow Creme D'Argent Cymric Dachshund Dalmatian Dandi Dinmont Terrier Dauchshund Devon Rex Doberman Pinscher Dogo Argentino Dogue de Bordeaux Domestic Long Hair Domestic Medium Hair Domestic Short Hair Donkey/Mule Dove Draft Duck Dutch Dutch Shepherd Dwarf Dwarf Eared Eclectus Egyptian Mau Emu English Bulldog English Cocker Spaniel English Coonhound English Lop English Pointer English Setter English Shepherd English Spot English Springer Spaniel English Toy Spaniel Entlebucher Eskimo Dog Exotic Shorthair Extra-Toes Cat (Hemingway Polydactyl) Ferret Field Spaniel Fila Brasileiro Finch Finnish Lapphund Finnish Spitz Fish Flat-coated Retriever Flemish Giant Florida White Foxhound Fox Terrier French Bulldog French-Lop Gaited Gecko Gerbil German Pinscher German Shepherd Dog German Shorthaired Pointer German Wirehaired Pointer Glen of Imaal Terrier Goat Golden Retriever Goose Gordon Setter Grade Great Dane Greater Swiss Mountain Dog Great Pyrenees Greyhound Guinea fowl Guinea Pig Hamster Harlequin Havana Havana Havanese Hedgehog Himalayan Himalayan Holland Lop Hotot Hound Hovawart Husky Husky mix Ibizan Hound Iguana Illyrian Sheepdog Irish Setter Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Italian Spinone Jack Russell Terrier Japanese Bobtail Japanese Chin Javanese Jersey Wooly Jindo Kai Dog Kakariki Karelian Bear Dog Keeshond Kerry Blue Terrier Kishu Komondor Korat Kuvasz Kyi Leo Lab Mix Labrador Retriever Lakeland Terrier Lancashire Heeler Leonberger Lhasa Apso Lilac Lizard Llama Lop Eared Lory/Lorikeet Lovebird Lowchen Macaw Maine Coon Maltese Manchester Terrier Manx Maremma Sheepdog Mastiff Mastiff Mix McNab Miniature Pinscher Mini Eskimo Mini-Lop Mini Rex Missouri Foxtrotter Mixed Breed Morgan Mountain Cur Mountain Dog Mouse Munchkin Munsterlander Mustang Mynah Neapolitan Mastiff Netherland Dwarf Newfoundland Dog New Guinea Singing Dog New Zealand Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norwegian Forest Cat Norwegian Lundehund Norwich Terrier Nova Scotia Duck-Tolling Retriever Ocicat Old English Sheepdog Oriental Long Hair Oriental Short Hair Oriental Tabby Ostrich Otterhound Paint/Pinto Palomino Palomino Papillon Parakeet (Other) Parrotlet Parrot (Other) Paso Fino Patterdale Terrier (Fell Terrier) Peacock/Pea fowl Pekingese Percheron Persian Peruvian Inca Orchid Peruvian Paso Petit Basset Griffon Vendeen Pharaoh Hound Pheasant Pigeon Pig (Farm) Pionus Pit Bull Terrier Pixie-Bob Plott Hound Poicephalus/Senegal Pointer Polish Polish Lowland Sheepdog Pomeranian Pony Poodle Portugese Podengo Portuguese Water Dog Pot Bellied Prairie Dog Presa Canario Pug Puli Pumi Quaker Parakeet Quarterhorse Ragamuffin Ragdoll Rat Rat Terrier Redbone Coonhound Retriever Rex Rhea Rhinelander Rhodesian Ridgeback Ringneck/Psittacula Rosella Rottweiler Russian Blue Saddlebred Saint Bernard St. Bernard Saluki Samoyed Satin Schipperke Schnauzer Scottie/terrier mix Scottish Deerhound Scottish Fold Scottish Terrier Scottie Sealyham Terrier Selkirk Rex Setter Shar Pei Sheep Sheep Dog Shepard Mix Shepherd Shetland Sheepdog Sheltie Shiba Inu Shih Tzu Siamese Siberian Siberian Husky Silky Terrier Silver Silver Fox Silver Marten Singapura Skunk Skye Terrier Sloughi Smooth Fox Terrier Snake Snowshoe Softbill (Other) Somali South Russian Ovcharka Spaniel Sphynx (hairless cat) Spitz Staffordshire Bull Terrier Standardbred Sugar Glider Swan Swedish Vallhund Tan Tennessee Walker Terrier Thai Ridgeback Thoroughbred Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Tiger Tonkinese Tosa Inu Toucan Toy Fox Terrier Treeing Walker Coonhound Turkey Turkish Angora Turkish Van Turtle Vietnamese Pot Bellied Vizsla Warmblood Weimaraner Welsh Corgi Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Westie Wheaten Terrier Whippet White German Shepherd Wire-haired Pointing Griffon Wirehaired Terrier Xoloitzcuintle/Mexican Hairless Yellow Labrador Retriever Yorkie Mix Yorkshire Terrier Yorkie
Colour	Amber Black Black and Brindle Black and Brown Black and Tan Black and White Black/Tan Black Tortie Black/White Blue Blue Tortie Brindle Brindle and Black Brindle and White Brown Brown and Black Brown and White Brown/Black/White Chocolate Chocolate Tortie Cinnamon Cinnamon Tortoiseshell Cream Fawn Fawn Tortoiseshell Ginger Ginger and White Golden Green Grey Grey and White Light Amber Lilac Lilac Tortie Liver Liver and White red Ruddy Seal Silver Sorrel Sorrel Tortoiseshell Tabby Tabby and White Tan Tan and Black Tan and White Tortie Tortie and White Tricolour Various White White and Black White and Brindle White and Brown White and Grey White and Liver White and Tabby White and Tan White and Torti White Mix Yellow and Grey
Description of the animal: *
Microchipped	Yes No
Spayed/Neutered	Yes No
Please list the vaccinations your pet IS up-to-date on. (We are primarily looking for rabies and distemper information.)
Owner First name *
Owner Last name
Email Address *
Address
Postcode
Mobile *
Please explain why you are needing to surrender this animal: