Surrender Form

Reason for surrender

Animal's name (one form per pet, unless a litter of kittens or puppies):

Animal type:

If kittens or puppies, how many (including mom)

Spayed/Neutered:

Description/breed:

Date of birth/approximate age:

How long have you had the animal:

How did you acquire the animal:

Lived with children:

Ages of children

Reaction to children

Lived with cats:

Reaction to cats:

Lived with dogs:

Reaction to dogs:

House trained:

Vaccines current:

Veterinarian's name and number:

Any medical or behavioral issues:

Anything else we should know about the animal?

Owner/Rescuer Release: I certify that I am the guardian of this animal and that I am legally entitled to transfer ownership to Grafelman Farms Rescue (GFR). I agree that GFR will do everything in its power to ensure a good home for the duration of this animal’s life. I permanently and irrevocably transfer ownership of this animal, with all rights, to GFR.

Date

Phone number

Name

Current Food Brand and Type of food (wet/dry)