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Pet Surrender Form

A free fillable pet surrender and relinquishment form for clinics, shelters and rescues. Record the history, sign on screen, then print or save as a PDF. Patient and owner details are never stored or sent anywhere.

Organisation

Receiving Organisation

Owner

Surrendering Owner

Animal

Animal's Details

History

History for Rehoming

Good with dogs
Good with cats
Good with children
Has this animal ever bitten a person or another animal?

(including details of any bite history - this protects future carers and adopters)

Declaration

Surrender Declaration

I declare that I am the lawful owner of the animal described above, or am authorised by the owner to surrender it, and that I permanently surrender this animal and transfer all ownership rights to the receiving organisation named on this form. I understand that the organisation will make all future decisions about the animal's care, including assessment, treatment, desexing, rehoming and, where judged necessary on health or welfare grounds, euthanasia, and that the animal will not be returned to me unless the organisation agrees. I authorise the transfer of the microchip registration. I declare that the information I have provided, including bite history, is true and complete, and I understand that withholding behavioural history can put future carers at risk. I confirm that I am over the age of 18 years.

Surrendering owner signature
Staff signature
Preview

Pet Surrender Form

Live preview · prints exactly like this

Pet Surrender Form

Receiving Organisation

Date of surrender

Surrendering Owner

First name
Last name
Address
Phone
Email

Animal's Details

Name
DOB (age)
Microchip
Weight (kg)
Gender
Species
Breed
Colour

History for Rehoming

Reason for surrender
Vaccination status
Usual diet
Medical history and current medications
Good with dogs
Good with cats
Good with children
Has this animal ever bitten a person or another animal?
Behavioural notes

Surrender Declaration

I declare that I am the lawful owner of the animal described above, or am authorised by the owner to surrender it, and that I permanently surrender this animal and transfer all ownership rights to the receiving organisation named on this form. I understand that the organisation will make all future decisions about the animal's care, including assessment, treatment, desexing, rehoming and, where judged necessary on health or welfare grounds, euthanasia, and that the animal will not be returned to me unless the organisation agrees. I authorise the transfer of the microchip registration. I declare that the information I have provided, including bite history, is true and complete, and I understand that withholding behavioural history can put future carers at risk. I confirm that I am over the age of 18 years.

Surrendering owner name
Date signed

Surrendering owner signature

Received by (staff member)
Photo ID sighted

Staff signature

Built by Dr Duncan Houston for Ask A Vet · askavet.com

Nothing typed into this form is sent to or stored by askavet.com. All data stays in your browser and leaves only in the PDF or printout you create. Surrender and rehoming rules, holding periods and microchip transfer requirements vary by state. This template is general in nature; adapt it to your organisation with your own adviser where needed.

Dr Duncan Houston
About the author

Dr Duncan Houston · BVSc, Veterinarian

Emergency careGeneral practiceMobile vet careFounder, ASK A VET™

Dr Duncan Houston is an Australian veterinarian with experience in emergency, general-practice and mobile veterinary care. He is the founder of ASK A VET™. This guide is educational and is not a substitute for hands-on veterinary care.

When Remember is on, this page saves your clinic's details in this browser only. Owner and patient details are never saved. It is never sent to Ask A Vet. Use Forget to remove them from this computer.