Animal Surrender Form

First Name *
Last Name *
City *
Address *
State *
Zip Code *
Cell Phone Number *
Email *
Pet's Name *
Breed *
Age of Pet
Gender of Pet *
What Color(s) are your pet? *
Size or Weight of Pet *
Microchip Number *
Where did you get your pet from? *
What is the reason for Surrender? *
What Vet did you take your pet to? *
Do you agree to bring your pet's medical records with you? *
Is your animal spayed/neutered? *
Does your animal have any health concerns? *
Is your animals on a special diet? *
Is your animal on flea and tick and heartworm preventatives? *
Does your animal tolerate having their nails trimmed? *
Is your pet housebroken? *
Where is your pet kept when you are not home? *
Does your pet live with other pets? *
How does your pet do with dogs? *
How does you pet do with cats? *
How does your pet do with children? *
Has your pet shown any signs of aggression? *
Has your pet ever bit a child or adult? *
How many times, and what were the circumstances? *
Is this an indoor or outdoor pet? *
What commands or tricks does your pet know? *
Does your pet have any likes or dislikes that you want the new owner to know? *
I hereby affirm that the above information is true, accurate and complete to the best of my knowledge. If any of this information is untrue, I agree to pick up my animal from The Community Humane Shelter of Steuben County within 2 business days. I understand there is no guarantee that The Community Humane Shelter of Steuben County will take my pet. I agree to pay a non-refundable $40 surrender fee. *