Name:

 

Date:

 

Full Address:

 

Day Phone Number:

 

Evening Phone Number:

 

Email:

 

Year of birth:

 

How would you like to be contacted by (phone, email, or either)?:

 

Number of animals you are surrendering?:

 

Species of animal you are surrendering:

 

Where did you get the animal(s) from (breeder, bred yourself, pet store, friend/family, etc)?:

 

Animal's name(s)?:

 

Animal's age(s) or DOB?:

 

Animal's breed(s)?:

 

If purebred, will the animal(s) come with papers?:

 

Animal's color(s)?:

 

Animal's size(s)?:

 

Animal's gender(s)?:

 

Are any of the animal(s) neutered?:

 

For rabbits, we require owner-surrenders to get the rabbit neutered for $55/neuter. Are you willing to pay to get the animal neutered and transport it as directed?:

 

Are you willing to pay the medical expenses if the animal is found to have other health issues?:

 

Animal's personality(ies)? Please be specific:

 

Is the animal(s) aggressive (biting, thumping, growling, etc)?:

 

Is the animal(s) litter trained?:

 

Has the animal been housed inside or outside?:

 

Wire-cage bottom or a plastic-cage bottom?:

 

What kind of litter has been used? What brands?:

 

What kind of diet is the animal being fed? What brands?:

 

Has the animal(s) had previous health issues or previous litters?:

 

Does the animal(s) have any current health issues?:

 

Is the animal good with other species?:

 

Is the animal bonded to another animal(s) of the same species?:

 

Is the animal currently in your care?:

 

Is the animal currently in any danger (abuse, neglect, free-roaming, etc)?:

 

Why are you surrendering? Please be specific:

 

Are you willing to make a monetary donation along with the animal(s)?:

 

Are you willing to donate supplies along with the animal(s)?:

 

Are you willing to transport the animal(s) as directed?:

 

Are you willing to sign the animal(s) over to the rescue?:

 

Do you have any questions or comments?:

 

Please enter the text shown below to prove you're human:

 

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