Pet Surrender Form
Receiving Organisation
- Date of surrender
Surrendering Owner
- First name
- Last name
- Address
- Phone
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