ACAS Dog Owner Surrender Form

To ensure your application is processed, please provide all the required information, including your veterinarian's phone number. Thank you! Additionally, please complete the Owner Surrender Form in its entirety to help us process your request in a timely manner.

Animal's Name *
First Name *
Last Name *
Address *
City *
State *
Zip Code *
What city/county do you reside in? * We do require current proof of residency and a current photo ID.	Athens City Limestone County Madison County Madison City Morgan County Lauderdale County
Phone Number *
Email Address *
Photo of your driver's license * Two proofs of residency are required for all surrenders, such as a current utility bill, credit card statement, or lease matching your driver's license name and address.
Please attach a photo of proof of residency. * Two proofs of residency are required for all surrenders, such as a current utility bill, credit card statement, or lease matching your driver's license name and address.
Gender of the animal *
What breed/type of animal? *
Second breed if the animal is mixed breed.
Primary color? *
Secondary color
Color markings * Spotted, patches, etc.
Coat Length *	Short Medium Long Wire Corded
Age? *
Animal is good with * Please check all that apply. This will help us in placing the animal in the best environment.	Kids under 5 Kids over 12 Small dogs Medium dogs Large dogs Cats or small animals House-trained or litter box trained Walks well on leash
Has issues with * This information is necessary in order for us to help find the appropriate placement in either the shelter, foster home, rescue or forever home.	None Food or toy aggression Aggression towards people or other animals Separation anxiety Destructive behavior - chewing, digging Inappropriate bathroom usage Excessive barking or howling Jumping fence or running off
Please describe the animal(s) personality, etc in detail. *
Has the animal been spayed or neutered? *	Yes No Unknown
Veterinary Clinic *
Veterinary Clinic Phone Number *
What is the name on the account that the animal is registered under? * This will allow us to get your animal's most recent medical record so that you don't have to bring in a copy.
How did the animal come into your possesion *
Name of rescue or shelter that you adopted the animal from? * Name of the rescue or shelter that you adopted the animal from.
Please provide the name & contact information of the person that you got the animal from? * Name and contact information of the person that you got the animal from.
How long have you had the animal(s) *
Why are you wanting to turn in the animal? *
How soon do you need to surrender your animal(s)? * Due to limited kennels, animals being surrendered, will only be accepted immediately if kennel space exists. If there is no adequate kennels available, you will placed on a wait-list in the order that your form was received.
Are you able to keep the animals while we work to find space in the shelter or with a foster? * Due to high intakes and limited space, owner surrenders are the first to be at risk for euthanization, due to lack of kennel space. In order to avoid this we work with local rescues to move out shelter animals. We ask that you help us by giving us time to find a space for your animal, so that they are not at risk.	Yes No
If you had help with food or spay/neuter costs would you be able to keep the animal(s)? *
Photo #1 * Please attach a photo showing the face of the animal for identification.
Photo #2 * Please attach a photo showing the size of the animal. This is needed to ensure that we have an appropriate sized kennel or cage.
Photo #3 * Please attach a photo showing the size of the animal. This is needed to ensure that we have an appropriate sized kennel or cage.
Signature * I have been honest and truthful in all my answers above. If I have not be truthful, I understand that my Owner Surrender Application can not be processed. I understand that I am relinquishing all rights to above animal(s) and the animal(s) will not be returned to me, without going through the adoption process. Due to the constant state of the shelter being at max capacity, it is understood that Owner Surrender animals, are the first at risk of being euthanized for space as we are NOT a no-kill shelter. Our Intake Coordinator will be in contact with you once your form has been processed. This can take 3-5 business days and does not guarantee a space until an adequate kennel is available to house your pet.