Pet Surrender Agreement

Note - this is not an application to rehome your pet. It is only to be used if SWS has agreed to take your pet into the rescue.

Instructions

* are required fields

Date *

Owner Information

Full Name *

Email *

Phone *

Address *

Country

City

State

Zip code

About Your pet

Is pet a dog or cat? *

Dog

Cat

Pet name *

Approximate age *

Approximate date adopted/acquired? *

Medical Information

Veterinarian Name *

Date of most recent vaccinations *

Current heartworm prevention? *

Date and type

Is the pet sterilized (spayed or neutered)? *

Yes

No

Behavior

Is pet housbroken? *

Yes

No

Good with Children? *

Yes

No

Good with dogs? *

Yes

No

Good with cats? *

Yes

No

Has the pet ever bitten a person or other animal? *

Yes

No

Can you help us?

Are you able to make a donation to our rescue to help care for your pet? *

Yes

No

If so, how much?

THANK YOU!

Agreement

Please describe why you are surrendering your pet *

By submitting this form you attest that you are the owner of the pet you are surrendering or that you have the legal right to do so. You understand and acknowledge that you no longer have any rights to this pet. Any refund of adoption fee (if applicable) represents the full extent of liability as a result of this transaction.

Make sure you are human *

For security verification, please enter any random two digit number. For example: 78

Saving Shelter Dogs & Cats in the Florida Panhandle

Surrender