Owner Surrender / Citizen Turn In

Owner Name:

Date:

Address:

Home phone:

Alternate phone:

Dog's Name:

Sex:

Breed:

D.O.B./Current Age:

To your knowledge has this animal bitten or showed potential to bite in the past:

If yes, please describe the incident

Driver's License and/or Vehicle Plate Number:

Spayed/Neutered:

How long have you owned the dog?

Reason for Surrender:

Transfer facility/organization:

ACFA License #:

Address:

City:

State:

Zip Code:

Transport/Volunteer Name:

Driver's License or Vehicle Plate Number:

* If animals are being received from out of state facilities, attach health certificate and rabies vaccination information **

If NTTSARS feels any transferred animal(s) is found to be a danger to the public or is in a state of extreme physical suffering, NTTSARS has the right to humanely euthanize.

NTTSARS will assume legal ownership of animal transferred upon arrival until the legal adoption of the animal.

When left alone my dog: (Check all that apply)

My dog is afraid of: (Check all that apply)

My Dog knows the following basic Commands: (Check all that apply)

Additional commands:

Please describe your dog’s overall demeanor:

My dog has the following health concerns:

My dog is currently on this medication:

Other helpful information about my dog:

Name the 3 best qualities of your dog. Also name the 3 worst qualities of your dog:

Are you able to provide veterinary or any other records for this pet? Please attach them below.

If this is not your dog please explain how it came to be in your possession .

● The above information reflects the animal in which I am surrendering to NTTSARS

● I understand that once I sign this form, the animal becomes legally owned by NTTSARS and I have forfeited any rights.

● NTTSARS will now be responsible for all financial responsibility associated with the animal (unless otherwise discussed). NTTSARS does not require a surrender fee, but a donation is appreciated. All donations are tax deductible.

Signature:

Date:

Are you willing to pay a surrender fee to offset the expenses?

Representative of No Time To Spare Animal Rescue: