Richardson Humane Society Intake Form - Owner Surrender

You can save your current form progress and come back later.

Save Progress

Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Pet Origin

Where did this pet come from?

Owner surrenderReturn to RHSStray from Friend of RHS/VolunteerStray from community memberShelter

Please provide more detail about where the pet came from

Please name the shelter of origin, original adoption date or other relevant detail.

What is the pet's name? (If return, what was pet's RHS name?)

Date pet acquired

Are you the person requesting that we take in this pet? If not, please give name and contact info of person requesting.

If this pet is being returned or is an owner surrender, what is the reason?

History

Does this pet have a history of aggression towards other pets or people or has this pet ever bitten a human?

YesNo

If you answered yes above, please describe

Pet Information

Pet Type

DogCat

Breed (if known)

Sex

MaleFemale

Age or Date of Birth

Weight

Less than 15 lbs16 to 35 lbs36 to 70 lbsOver 70 lbs.

Is the pet microchipped?

YesNoDon't know

Is the pet spayed or neutered?

YesNoDon't know

Does this pet have any medical conditions we should be aware of? If so, describe.

Please describe the personality of this pet.

Placement

Will you foster this pet until it's adopted?

YesNo

Is an open foster home available at RHS? If so, who?

Are you willing to make a financial contribution toward this pet's care?

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.

You can save your current form progress and come back later.

Save Progress