Animal Intake

I, the owner, or authorized agent of owner, do hereby relinquish all and any claims to the animal described below, and grant custody of said animal to the Hancock County Animal Shelter to do with as policy and state law permit. By signing this release form i do also agree to release, forever discharge, and promise to hold harmless the Hancock County Commission and the Hancock County Animal Shelter, their employees, servants, and agents from all claims, demands, damages, actions and cause of action, whatsoever. To the best of my knowledge and belief this animal has not bitten any person during the ten days preceding this date. Please understand after signing this release form your animals will be subject to the Hancock County Animal Shelter's spay and neuter policy and will be spayed or neutered if adopted by you or any other party. *

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Primary Phone Number *

Secondary Phone Number *

Email

Are you the owner?

Owner's First Name

Owner's Last Name

Owner's Address

Owner's City

Owner's State

Owner's Zipcode

Owner's Phone Number

Reason not brought in by owner:

Location where picked up, if stray:

Surrendering Signature *

Name of Vet Clinic

Under what name

Medical Records Attached

Current Rabies Vaccine

Date of most recent rabies vaccine

Pet's microchip number

Good with Kids

Good with Cats

Good with Dogs

House (litter) trained?

Any other health or behavior issues we should know about to help find the best possible fit for adoption?

Why do you have to surrender this animal today?

Any unique markings to identify?

Photo of animal

Pet's Name *

Type *

Species *

If other, please specify species

Breed (if unsure please list closest guess) *

Approximate Age *

Color *

Gender *

Please take photo of surrendering's photo ID. *

Signature of Shelter Staff Handling Intake:

Staff Notes