2. This form will help us better understand your pet. Please answer as openly and honestly as possible.
4. First and Last Name*
6. Address 1*
8. Address 2
10. City*
11. State*
12. Zip*
14. Phone Number*
16. Email Address*
18. Why do you need to surrender your pet(s)?*
    -- Select One --Housing Issues - HomelessnessHousing Issues - MovingHousing Issues - Breed Restrictions / Pet Rent / Pet Deposit FeesHousing Issues - OtherFinancial Issues - Cannot afford food and/or vet careFinancial Issues - OtherBehavioral Issues - Aggression to PeopleBehavioral Issues - Aggression to other AnimalsBehavioral Issues - Escaping Behavioral Issues - Other
20. Would you be interested in keeping your pet if we helped with resources?*
    -- Select One --YesNo

    This can include but is not limited to: food, vaccines, spay and neuter appointments, dog houses, etc.

22. What type of animal are you surrendering?*
    -- Select One --DogCatOther
24. What breed is your pet?*
26. What color is your pet?*
28. Upload a photo of your pet here
30. Where did you get this animal from? (ex. friend, our shelter, another shelter)*
32. What is the name of your pet?*
34. How long have you had your pet?*
36. How old is your pet?*
38. Is your pet a male or female?*
    -- Select One --MaleFemale
40. Is your pet spayed or neutered?*
    -- Select One --YesNoNot Sure
42. Has your pet been around the following types of animals?*

    Please check all that apply

    1. Intact male dogs
    2. Intact female dogs
    3. Neutered male dogs
    4. Spayed female dogs
    5. Cats
    6. Other animals (chickens, goats, birds, etc.)
44. How did your pet react?*

    Were they friendly? Did they not like certain types of animals? 

46. Has your pet been around the following types of people?*

    Please check all that apply

    1. Women
    2. Men
    3. Children
    4. Strangers
48. How did your pet react?*

    Were they friendly? Did they not like certain types of people?

50. Does your pet have any medical concerns?*

    Do they have allergies? Are they on a specific type of food? Do they take daily medications?

52. Does your pet have any behavioral concerns?*

    Do they resource guard food or toys? Do they not like men?

54. Once you submit this form, a staff member will give you a phone call to discuss setting up a date/time to surrender your pet.
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field