Surrender Form

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

* GenderMaleFemale

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Surrender Application

Please submit the following form to receive resources for keeping or re-homing your pet, or to request a surrender appointment. The more information you can provide us about your pet and your situation, the better we will be able to assist you. We want to help you keep your pet whenever possible, so be sure to indicate which services may be of benefit to you. It can take up to five business days for someone to get back to you. Please be sure to check your junk and spam folders for our emails as well. If you are inquiring about surrendering your pet, please note that we may not be able to immediately accommodate your request. This means that our shelter population is over-capacity. We urge pet owners to exhaust all options and resources provided before surrendering their pet so that we are able to reserve space for animals with the greatest need. The surrendering fee is $80 per pet.

Please tell us why you're considering surrendering your pet: (if stray, which area was the fur-baby found?)

Pet's Name

Species

CatDogOther

Color

Breed

Age

Sex

MaleFemale

Is the pet Spayed/Neutered?

YesNoUnknown

How long have you had this pet?

Has this pet been kept:

InsideOutsideBoth

Is this pet housebroken?

YesNo

What is this pet's activity level?

HighMediumLow

Would you recommend this pet to be placed in a home with:

Adults onlyFamily w/ younger childrenFamily w/ older childrenCat(s)Dog(s)Other

Describe the pet's attitude towards children? (i.e., likes, dislikes, fearful, friendly, or aggressive)

Describe the pet's attitude towards strangers? (i.e., likes, dislikes, fearful, friendly, or aggressive)

Describe the pet's attitude towards Dogs? (i.e., likes, dislikes, fearful, friendly, or aggressive)

Describe the pet's attitude towards cats? (i.e., likes, dislikes, fearful, friendly, or aggressive)

Describe the pet's attitude towards other animals? (i.e., likes, dislikes, fearful, friendly, or aggressive)

what brand of food are you currently feeding this pet?

Please give more information you may have for this pet.

Has this pet shown any signs of aggression, either towards people and/or other animals?

YesNo

Has this pet bitten anyone in the past 10 days?

YesNo

Does this pet have any medical problems that you are aware of?

What assistance are you requesting?

Help to re-home fur-babySurrender AppointmentTemporary boarding StrayOther

Owner/Custodian

As lawful owner or custodian of the pet describe, I hereby transfer all rights and relinquishment ownership to the Delta Humane Society SPCA of San Joaquin County, a NO KILL animal shelter. I also hereby certify that all of the above information is true and correct. If any information in this form has been falsified, I will be required to retrieve the animal. Failure to reclaim the animal after being notified will result in legal action.

Please upload the most updated picture of the fur-baby

Upload most recent medical records of fur-baby

any other documents you would like to provide

Any other documents you would like to provide

By submitting this form, you agree with all terms and conditions

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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