Animal Intake - Surrender Application

The HSCC is a selective admission shelter. Please understand we cannot accept every animal brought to us.

While we respect the difficult decision of owners relinquishing their pets, we will only accept the surrender of adoptable owned pets that fit our criteria and based on our capacity and resources.

Note: The submission of this form does not guarantee that the HSCC will take your pet. This form gives our staff more information about the pet. The HSCC has the right to refuse any pet that does not meet our intake guidelines.

Your first name and middle initial: *
Your last name: *
Your physical address: *
City you reside in: *
State you reside in: *
Zipcode for your area: *
Your home phone #:
Your cell phone #: *
Your e-mail address:
Are you 18 years of age or older? *
Please upload a picture of your driver's license: *
Select whichever is applicable to your situation: *
Reason for surrender: *
Pet's Name: *
Reason for surrender: *
Pet's Name: *
Species *
Is the pet male or female? *
If other, what animal: *
Is the pet spayed or neutered? *
There is a surrender fee of $100.00 for an unaltered cat.
There is a surrender fee of $50.00 for an altered cat (with proof of spay/neuter).
There is a surrender fee of $60.00 for an altered dog (with proof of spay/neuter).
There is a surrender fee of $120.00 for an unaltered dog.
There is a surrender fee of $120.00 for an unaltered dog.
There is a surrender fee of $100.00 for an unaltered cat.
Pet's primary breed: *
Is the pet a mix breed? *
If a mix breed, please select a secondary breed: *
Pet's approximate date of birth: *
Veterinarian(s) Used? *
Pet's weight/size: *
To the best of your knowledge, has this animal bitten any human? *
If yes, please explain the circumstance and severity of the bite: *
To the best of your knowledge, has this animal bitten any other animals? *
If yes, please explain the circumstance and severity of the bite: *
Has the pet ever shown aggression to people? *
If yes, please explain: *
Does the pet have food or toy aggression? *
List any things special about the pet which will assist us in making the pet as comfortable as possible during their stay with us.
What's your pet's activity level? *
Is the pet housebroken/litter trained? *
Does the pet have basic obedience training/know commands? (Sit, Down, Stay, etc.) *
Please indicate what commands the pet may know: *	Sit Down Stay Come Heel Off No Shake/Paw Speak
Is the pet leash trained? *
Is the pet good with children? *
Is the pet good with other dogs? *
Is the pet good with other cats? *
Is the pet good with other animals? *
During the day pet stays: *
At night pet stays: *
If pet is not confined outside, will it run away? *
Is the pet allowed on furniture? *
Is the pet currently taking medications? *
If yes, please explain:
Pet's favorite food:
Pet's favorite treats:
Pet's feeding time/amount:
Pet's favorite toy:
Pet is afraid of:
Pet enjoy car rides?
In what situation, if any, will the pet bite or scratch?
Please describe your pet's personality or give additional information you would want the new owner to know:
Please upload a picture of your pet: *
The HSCC is a private, nonprofit corporation with no government or corporate funding. The HSCC is a selective admission shelter. The admission of any animal into the HSCC is dependent upon the animal's health and temperament. When we admit a pet to our shelter, we are committed to providing for its care until it is adopted. Euthanasia is not considered for adoptable animals because of lack of space or duration of stay. Animals deemed an unacceptable danger to other animals, themselves, the public or animals suffering physically or emotionally may be candidates for euthanasia. Once a surrender application is submitted staff will review the application for the animals eligibility. We will contact you to setup a surrender appointment. There is a $25 deposit required to hold your appointment. If we accept the animal, the $25 is applied to the surrender fee. If you don’t show for the appointment, the $25 is forfeited as a donation. Please allow a minimum of 30 minutes for the evaluation process. The submission of this application does not guarantee that the HSCC will take your pet.
Signature: *