Owner Surrender Information Form

Thank you for using our online submittal form. Please note that animals will also need to have a photo emailed. Shelter staff will respond to you within 48 hours of receipt, excluding Sundays and holidays.

Owner Information

Owner's Name:

Owner's Phone Number:

Owner's Email:

Owner's Address:

Owner's City:

Owner's State (Please use two letter abbreviation):

Owner's Zip:

Owner's Mailing Address (if applicable):

Owner's Mailing City:

Owner's Mailing State (Please use two letter abbreviation):

Owner's Mailing Zip:

Animal Information

Animal's Name:

Animal Species: (for example: dog, cat, bird, etc)

Animal's Breed:

Animal's Age:

Animal's Approximage Weight:

If a litter, how many in the litter:

Animal Color/Markings:

Animal Sex:

Is your animal spayed/neutered (fixed)?

Is your animal microchipped?

How Long Have You Had This Animal?

Where Did You Get This Animal?

Please Explain Why You Are Surrendering Your Pet (be detailed)*

Behavior Questions

Has This Animal Ever Bitten Anyone?

If yes, when did the most recent bite occur and what were the circumstances?

Has this animal ever shown aggression toward humans? If so, please explain the situation.

Is this animal friendly with dogs?

Is this animal friendly with cats?

Is this animal friendly with livestock?

Where does this animal primarily live?

Does this animal like children? If so, do you recommend them for placement in a home with children?

How does your animal react to people it does not know?

Is this animal housebroken?

If animal is a horse, is this animal trained to be ridden? What level of rider would you suggest?

Health Questions

Does this animal have any health issues? If so, what are they?

Any previous injuries or illnesses? What were the symptoms?

Is this animal currently on any medication (including flea/tick preventative)?

When was the last time this animal saw a veterinarian?

When was this animal’s last vaccinations? What vaccines were given?

What brand of food does your animal currently eat?

* A photo is required to process your application. Instructions on how to submit a photo are provided after you click on the Submit Button.