Waiting List Entry

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

Country

*State/Province

Pet Information

Information about the pet you are considering surrendering.

How many

How many pets are you looking to rehome?

How long

How long have you had this pet or these pets?

Age

How old is your pet?

Under 6 monthsBetween 6 months and 2 years2 - 5 years6 or greaterUnknown

Relationship to the pet

What is your relationship to the pet?

OwnerNot the owner, but providing care for itNot the owner, but contacting you on their behalf

Pet Name

What is the name of the pet?

Species

What type of animal is your pet?

DogCat

Spay/Neuter

Is your pet spayed/neutered?

YesNo

Why

Why are you wanting to surrender this pet? Please provide a detailed description.

Other details (socialization, special needs, etc.)

Any other details you would like to provide about this pet.

Surrender Fee

Great River Rescue is a private, nonprofit organization that depends on community support to continue our mission of saving companion animals. At the time of surrender, we ask for $25 per altered pet, and $50 per unaltered pet (Maximum $250 for a litter). Do you understand?

YesNo

Up-to-date with vaccinations?

Were your cats updated on vaccines in the past year or your dogs updated on vaccines in the past 2 years?

YesNo

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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