TRHRP Animal Surrender Form

By signing below, I certify that I am the legal owner of the animal described in this form, or that I have the legal authority to surrender the animal.

I voluntarily surrender this animal to The Road Home Rescue Project. Upon acceptance of the surrender, I understand that I relinquish my ownership of and legal rights to the animal to The Road Home Rescue Project and that the rescue will determine the animal's care and placement based on the animal's needs, available resources, and the rescue's policies.

I certify that the information provided on this form is true and complete to the best of my knowledge. I understand that it is important to disclose all known medical conditions, behavioral concerns, bite history, aggression, and other relevant information to help ensure the safety and well-being of the animal, foster caregivers, volunteers, adopters, and other animals.

I understand that surrendering an animal does not guarantee adoption, foster placement, or any other specific outcome.

I agree to provide any veterinary records, vaccination records, microchip information, or other relevant documents in my possession.

I have read, understand, and agree to the above surrender terms.

1. Surrenderer Information
Full Name *
Address *
City *
State *
ZIP *
Phone *
Email *
Confirm email
Preferred Contact Method (check all that apply)
	Phone
	Text
	Email
Are you the legal owner of this animal? (choose one)
	Yes
	No
If no, please explain
2. Animal Information
Animal's Name
Species (choose one)
	Dog
	Cat
Breed / Mix
Sex (choose one)
	Male
	Female
Spayed / Neutered (choose one)
	Yes
	No
	Unknown
Date of Birth / Approximate Age
Color / Markings
Approximate Weight
Microchipped (choose one)
	Yes
	No
How long have you owned the animal you are looking to surrender?
Where did you obtain this animal? (check all that apply)
	Shelter / Rescue
	Breeder
	Pet Store
	Friend / Family
	Found as Stray
	Other
If other, please specify
3. Reason for Surrender
Why are you surrendering this animal? * Please provide as much information as possible.
Have you tried other solutions before requesting surrender? (choose one)
	No
	Yes
If yes, please explain
Would you be willing to keep the animal while the rescue searches for placement? (choose one)
	Yes
	No
If no, please explain
4. Behavior & Temperament
How would you describe the animal's temperament? (check all that apply)
	Very Friendly
	Friendly
	Shy / Fearful
	Nervous
	Protective
	Aggressive
	Unknown
Has the animal ever bitten or attempted to bite a person? (choose one)
	No
	Yes
	Unknown
If yes, please describe what happened
Good with Adults (choose one)
	No
	Yes
	Selective
If selective, please explain
Good with children (choose one)
	No
	Yes
	Unknown
If yes, please include the ages of children the animal has been around
Good with Dogs (choose one)
	No
	Yes
	Unknown
Good with Cats (choose one)
	No
	Yes
	Unknown
Does the animal guard food, toys, beds, or other items? (choose one)
	No
	Yes
	Unknown
If yes, please explain
Does the animal have separation anxiety? (choose one)
	No
	Yes
	Unknown
Does the animal display destructive behavior? (choose one)
	No
	Yes
	Unknown
Is the animal house-trained / litter-trained? (choose one)
	Yes
	No
	Unknown
Is the animal crate-trained? (choose one)
	Yes
	No
	Unknown
Other behavioral concerns
5. Home & Social History
Has the animal lived with children? (choose one)
	Yes
	No
	Unknown
If yes, please include their ages
Has the animal you are looking to surrender lived with other animals? (choose one)
	Yes
	No
	Unknown
If yes, please describe
Please provide any additional information about the current home environment for the animal you are looking to surrender Examples: crate trained, housebroken, separation anxiety, etc.
6. Vaccinations & Preventative Care
Rabies (choose one)
	Current
	Not Current
	Unknown
DHPP / Distemper (choose one)
	Current
	Not Current
	Unknown
Bordetella (choose one)
	Current
	Not Current
	Unknown
	N/A
FVRCP (Cats) (choose one)
	Current
	Not Current
	Unknown
	N/A
Heartworm Prevention (choose one)
	Current
	Not Current
	Unknown
	N/A
Flea / Tick Prevention (choose one)
	Current
	Not Current
	Unknown
Other Vaccinations / Preventative Care
Are there any known medical issues?
Any known allergies?
Is the animal you are looking to surrender on any medications currently? (choose one)
	No
	Yes
If yes, please list medications and the dosage and frequency
Veterinarian / veterinary hospital information
In order to help expedite the surrender, please provide your vet information and any medical records you have. Please also contact your vet and give them permission to provide vetting information on the animal you are looking to surrender.
7. Daily Care
Please provide any additional information on the animal you are looking to surrender Examples: dietary restrictions, current food, favorite treats, toys, activities, grooming frequency, exercise routine, etc.
8. Surrender Agreement
By signing below, I certify that I am the legal owner of the animal described in this form, or that I have the legal authority to surrender the animal. I voluntarily surrender this animal to The Road Home Rescue Project. Upon acceptance of the surrender, I understand that I relinquish my ownership of and legal rights to the animal to The Road Home Rescue Project and that the rescue will determine the animal's care and placement based on the animal's needs, available resources, and the rescue's policies. I certify that the information provided on this form is true and complete to the best of my knowledge. I understand that it is important to disclose all known medical conditions, behavioral concerns, bite history, aggression, and other relevant information to help ensure the safety and well-being of the animal, foster caregivers, volunteers, adopters, and other animals. I understand that surrendering an animal does not guarantee adoption, foster placement, or any other specific outcome. I agree to provide any veterinary records, vaccination records, microchip information, or other relevant documents in my possession. I have read, understand, and agree to the above surrender terms.
Suggested donation: $100, or any amount you can afford, to help offset medical costs and support our rescue mission. Donations are voluntary.
Surrenderer Name (Print) *
Signature *
Date *
Submitting the surrender request form does not guarantee a spot for your animal at TRHRP or secure an appointment for surrender. Our intake coordinator will be in contact following receipt of this form.

TRHRP Animal Surrender Form

1. Surrenderer Information

2. Animal Information

3. Reason for Surrender

4. Behavior & Temperament

5. Home & Social History

6. Vaccinations & Preventative Care

7. Daily Care

8. Surrender Agreement