Animal Surrender Form

Name of Animal *

Age *

Spayed / Neutered? *

Species & Breed *

How did you Acquire this Animal? *

How long have you had this animal?

Why are you surrendering this animal? *

Animal is good with *

Kids
Dogs
Cats
Other

Other:

Has this animal ever shown signs of agression? *

Yes
No

Please Explain

Has this animal ever bitten anyone? *

Yes
No

This animal has primarily lived: *

Indoors
Outdoors

This animal is:

House Trained
Create Trained

Is this animal current on vaccinations? *

Yes
No

Is this animal current on heartworm prevention? *

Yes
No

Name of Veterinary Hospital *

Date of last visit *

Other notes about this animal

By checking "I Agree" below I do freely and voluntarily give ownership of the animal(s) described herein to Nykol's Rescues. No one has forced, coerced, or threatened me to surrender the animal(s) and no promises or guarantees have been made for me to surrender the animal(s). I certify that I am the sole owner of the animal(s) described herein, or have the authority to surrender such animal(s). I also understand that I surrender all rights of ownership to Nykol's Rescues and understand that my pet my be adopted or transferred at any time without prior notice. *

I Agree

Your Name

Phone Number of Person Surrendering

Address of Person Surrendering

Address Line 1

Address Line 2

City

State

Zip Code

Today's Date