Surrender Form

First name

Last name

Address

Phone

Does anyone else have ownership rights to this animal? Please explain.

Animal Information

Animal Type

Age

Sex

Name

Spayed/Neutered

Weight

Color/Markings

Indoor/Outdoor

How would you describe the animal?

Compatible with Children?

Compatible with other animals?

Why are you surrendering this animal?

How/When did you obtain this animal?

Is the animal spayed/neutered? If yes, when and where?

Last vet visit? When and where?

Last Rabies vaccine? When and where?

Last Combo Vaccination (dogs - DAPP, cats - LRCPC)? When and where?

What is the animal's current routine?

What is the animal's current diet and feeding schedule?

What type of training does the animal have? (litter box, commands, etc)

Does the animal have any special needs or medical conditions? Any medications?

Any other pertinent information?

Surrender Fee will be discussed based on animal type, etc.

***Disclaimer - Green Acres Animal Rescue reserves the right to refuse intake of any animal.