League for Animal Welfare | Surrender Form

Surrender Form

* indicates required field

Animal Intake Information

* First Name: * First Name:

* Last name: * Last name:

* Phone: * Phone

* Address: * Address:

* City: * City:

* County: * County:

* State:

* ZIP Code: * ZIP Code:

* Email: * Email

* Dog or Cat?:

* Is the pet a stray? * Is the pet a stray?: Yes No

If no, why does your pet need to be rehomed?: If no, why does your pet need to be rehomed?

* Male or Female?:

* Neutered/Spayed:

* Approximate Age: * Approximate Age:

* Breed: * Breed:

* Color: * Color:

(If You Are Requesting Intake For Multiple Animals, Please Note Here the Number of Animals, Breeds, and Ages): (If You Are Requesting Intake For Multiple Animals, Please Note Here the Number of Animals, Breeds, and Ages)

If Owned (If Stray, Skip to Next Section)

Animal's Name: Animal's Name:

Where Did You Get Your Pet?: Where Did You Get Your Pet?:

Up-to-date on vaccines:

Friendly With? (Check All That Apply): Friendly With? (Check All That Apply):: Kids Cats Dogs

Housebroken/Litterbox:

Veterinarian Name: Veterinarian Name:

Veterinarian Phone: Veterinarian Phone

Why Does Your Pet Need To Be Rehomed?: Why Does Your Pet Need To Be Rehomed?

Please List Administer Dates For the Following:

Rabies Vaccination: Rabies Vaccination

Heartworm Prevention: Heartworm Prevention

Flea Medication: Flea Medication

If Stray (If Owned, Skip to Signature)

Date Found: Date Found

Location Address Found: Location Address Found:

Town Found: Town Found:

Neighborhood Found: Neighborhood Found:

Where Have You Posted Flyers/Social Media Alerts?: Where Have You Posted Flyers/Social Media Alerts?:

I hereby agree that the animal specified above, which I own or which I have custody or other knowledge of, shall become the property of the League for Animal Welfare, to be cared for or placed in a new home at the discretion of the League for Animal Welfare, without recourse on my part.

Furthermore, by signing below I understand I will no longer have contact with the animal unless they do not pass the temperament test.

* Signature: * Signature:

* Date: * Date

Please consider a donation to the League!

Your donation helps cover the cost of vaccinations, feeding, housing and staff time caring for your and many other of our community’s animals! Thank you for helping us help other dogs and cats find their loving families.