2. Surrender Application
Applicant's First Name
Applicant's Last Name
Street Address
City
State
Apartment Number (if applicable)
Zip Code
Phone Number
Please use the following format 248-555-1212
Email Address
Please enter correctly as this is the main way we will contact you
How did you find out about us?
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Instagram
Other
Have you applied to other rescues to surrender?
No
Yes
If yes, where else have you applied?
Is this pet currently owned by you?
Yes, myself
No Someone else
Do you own other animals that you wont be surrendering?
No
Yes
If yes, breeds and keeping reason.
How many animals are you wanting to surrender?
Please list their name, age, species
What is the main reason for surrendering?
Moving
Allergies
Work commitments
Does not get along with other animals or children
Aggressive
Medical Issues
Not enough time
Limited Money
Other
If you answered "other" above, please explain here:
Please describe in detail information about the animal/s such as medical history or any other important details
What diet is the animal/s currently on?
*
Please put brand names if you can, we don’t want upset tummies. If reptiles please list what and when they usually get fed.
Will you be surrendering the animal/s with anything? Ie. enclosures, bedding etc
Please describe as much detail as you can so we can ensure we have the space available
Has the animal/s seen a vet within the last year?
No
Yes
Do you understand that if you surrender then you are handing over all your rights of ownership?
No
Yes
Please upload photos of your animals you wish to surrender
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way.
Yes
No
Please sign
We will contact you regarding your application.
Clear
