Surrender Your Pet Form Surrender Your Pet Form I am surrendering my:*DogCatYour InfoName* First Last Animal PhotoPlease submit up to three (3) photos Drop files here or Select files Max. file size: 3 MB. Medical Records Drop files here or Select files Max. file size: 256 MB. Please submit your pet's medical recordsAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* ABOUT YOUR DOGDog Name* First Breed* Age* Age in:*YearsMonthsWeeksSex* Male Female Veterinarian Name First Last Veterinarian Phone NumberIs your dog up-to-date on vaccines?* Yes No Is your dog spayed / neutered?* Yes No Why are you surrendering your dog?*How old are the people that live in the home?*Does your dog live with other animals?* Yes No Other animals my dog has lived with*SpeciesAge How long have you owned your dog?*Where did you get him/her?*How does your dog greet strangers in your home?*How does your dog react to other dogs?*How does your dog react to other cats?*How does your dog greet strangers on walks?*How does your dog act with children?*How old are the children that your dog interacts with?*How much time does your dog spend alone and where is he / she kept?*How does your dog behave when left alone?*What kind of activities do you do with your dog?*How would you describe your household?*Is your dog house trained?* Yes No Has your dog ever gotten possessive over a bone, toy or food?* Yes No If yes, please explain:*Has your dog ever bitten and drawn blood?* Yes No If yes, what is the date of the latest bite where they have drawn blood?*Does your dog have medical or behavioral needs?* Yes No If yes, please explain:*ABOUT YOUR CATHow many cats are you looking to surrender?*12345+Cat #1 Name* First Cat #2 Name* First Cat #3 Name* First Cat #4 Name* First Cat #5 Name*If you are surrendering more than 5 cats, list all remaining cats names separated by commas. First Cat #1 Color* Cat #2 Color* Cat #3 Color* Cat #4 Color* Cat #5 Color*If you are surrendering more than 5 cats, list all remaining cats colors separated by commas. Cat #1 Age* Cat #1 Age in:*YearsMonthsWeeksCat #2 Age* Cat #2 Age in:*YearsMonthsWeeksCat #3 Age* Cat #3 Age in:*YearsMonthsWeeksCat #4 Age* Cat #4 Age in:*YearsMonthsWeeksCat #5 Age* Cat #5 Age in:*YearsMonthsWeeksIf you are surrendering more than 5 cats, list all remaining cats ages separated by commas. If you are surrendering 5 cats, write "N/A".* Cat #1 Sex* Male Female Cat #2 Sex* Male Female Cat #3 Sex* Male Female Cat #4 Sex* Male Female Cat #5 Sex* Male Female If you are surrendering more than 5 cats, list all remaining cats sex separated by commas. If you are surrendering 5 cats, write "N/A".* Veterinarian Name First Last Veterinarian Phone NumberIs your cat(s) up-to-date on vaccines?* Yes No Has your cat(s) been tested for FELV/FIV?* Yes No What were the results?* FIV positive FIV negative FeLV positive FeLV negative Is your cat(s) spayed / neutered?* Yes No Why are you surrendering your cat(s)?*How old are the people that live in the home?*Does your cat(s) live with other animals?* Yes No Other animals my cat has lived with*SpeciesAge How long have you owned your cat(s)?*Where did you get your cat(s)?*How does your cat(s) greet strangers?*How does your cat(s) react to other dogs?*How does your cat(s) react to other cats?*How does your cat(s) act towards children?*How old are the children that your cat(s) interacts with?*Does your cat(s) like to be held?*Is you cat(s)* Very social Independent Combo of social and independent Please describe all cats' personalities below:*If you had a houseful of people how would your cat(s) react?*Is your cat litter box trained?* Yes No If surrendering more than 1 cat, please indicate if any of your cats are not litter box trained below:*Is your cat declawed?* Yes No If surrendering more than 1 cat, please indicate if any of your cats are declawed below:*Has your cat(s) ever bitten and drawn blood?* Yes No If yes, what is the date of the latest bite where they have drawn blood?*Does your cat have medical or behavioral needs?* Yes No If yes, please explain:*If surrendering more than 1 cat, please indicate below all cats that have medical or behavioral needs:Any additional information we should know about your cat?*Is there anything we can do to help keep your pet in your home instead of surrendering?*CommentsThis field is for validation purposes and should be left unchanged. Δ
