Surrender Form

First Name *

Last Name *

Address *

City *

State *

County *

Zip Code *

Primary Phone Number *

Email Address *

Confirm email

What Type Of Animal and How Old *

Where does this pet primarily live *

Is this animal spayed or neutered? *

If a dog please list the breed(s)

Please explain the reason for surrender ? *

is this pet other animal friendly *

Is this pet comfortable with people handling it *

How long have you had this animal(s) in your care *

Are there any behavioral quirks (dislikes) we should know about *

Any medical concerns we should know about *

What is your preferred method of contact *

If you are looking to surrender a dog or puppy, please send a photo of each animal to cstewart@hcaswv.org after submitting this form.

Thank you for choosing us to assist you with finding a new home for an animal. Your inquiry has been received, and our team will be reaching out to you shortly via email (or phone if specifically requested) to guide you through the next steps. Should you have any questions or need assistance with this form, feel free to reach out to us at cstewart@hcaswv.org or call us at 304-387-4102. We're here to help! *

Signature *