Animal Surrender Form

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

Animal Information

Animal's Name

Breed

Age/D.O.B

Color/Markings

Gender

MaleFemale

Spayed/Neutered

YesNoUnknown

Microchip Number

Animal History/Behavior

Medical Conditions

Please list all conditions for this animal, past and current

Current Medications

Please list all current medications

Behavioral Concerns

Please list any behaviors concerns including any bite history

Good with:

Dogs CatsChildrenStrangers

Reason For Surrender

Need Assistance to keep Animal

Do you need any type of assistance for animal care?

Food AssistanceMedical CareOther

Owner Release Statement

I,hereby surrender the above-described animal to Wags-Whiskers, I understand that:

I am relinguishing all legal rights and ownership of this animal
The shelter may place the animal for adoption, transfer it to another organization, or make other decisions in the animal's best interest.
The shelter cannot guarantee updates on the animal's status after surrender.

Owner's Signature

Signature Please use your mouse or finger (if on phone/tablet) to sign

* Date Signed

* Full Name

Date:

Shelter Representative Signature: