Pet Surrender Form

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SAN ANTONIO HUMANE SOCIETY SURRENDER AGREEMENT

The following questionnaire provides us with important information about the animal you are surrendering. This information will help us find the most suitable home for the animal and effectively cousel their new family. Your open and honest answers are very much appreciated!

Name(Required)

First Last

Today's Date(Required)

Month

Day

Year

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Photo(s) of your pet(Required)

Drop files here or

Max. file size: 32 MB, Max. files: 5.

Veterinary/Vaccine Records

Max. file size: 32 MB.

The transition to daily life in an animal shelter can be highly stressful for some pets as there are many new sounds, smells, and other animals. In the event that SAHS staff determines this animal is not adapting well to life in the shelter environment and is not a candidate for adoption, would you be willing to reclaim him/her?(Required)

Yes, I would like to reclaim this surrendered pet.

No, I would not like to reclaim this animal.

Certification of Information(Required)

I hereby certify that the information provided is accurate and truthful to the best of my knowledge, that I am the legal owner of the animal(s), and that the animal(s) have not bitten any person during the last 10 days.

Signature(Required)

I hereby release the animal(s) into the custody of the San Antonio Humane Society (SAHS). The SAHS has my permission to use its best judgement in the placement of the animal(s). I understand that once the SAHS takes custody of the animal(s) I will be unable to reclaim ownership or adopt the animal(s) unless expressly requested by SAHS staff.I understand that although the SAHS strives to place all adoptable animals in homes, any animals determined to be un-adoptable for any reason may be euthanized. These reasons include, but are not limited to, illness or injury that the SAHS is unable to treat and/or temperament issues that are beyond rehabilitation.

Are you surrendering a cat or dog?(Required)

Cat

Dog

CAT SURRENDER FORM

Cat's Name(Required)

Breed(Required)

Age(Required)

Weight(Required)

Sex(Required)

Female

Male

Is this cat spayed or neutered?(Required)

Yes

Is this cat declawed?(Required)

Yes

Any declawed cat must be friendly, and you must be willing to reclaim if they start having difficulty adapting to the shelter.

Is this cat microchipped?(Required)

Yes

Is the microchip registered to you?(Required)

Yes

Please provide the microchip number

General History

Why are you surrendering this cat? Please be as detailed as possible!(Required)

How long have you had this cat?(Required)

Including yours, how many homes has this cat had?(Required)

If this cat came from another rescue group or shelter, please list them:

If this cat was adopted from the SAHS, please provide their animal ID:

Personality and Behavior

Would you describe this cat as loud / talkative?(Required)

Yes

Does this cat enjoy being held?(Required)

Yes

Describe this cat's energy level(Required)

Coach Potato	Lower Energy	Neutral	Active	Very Active

Describe this cat's social personality(Required)

Very independent	Independent	Neutral	Social	Social Butterfly

Describe this cat's affection level(Required)

Reserved	Somewhat Reserved	Neutral	Somewhat Loving	Very Loving

Describe this cat's fear level(Required)

Very Timid	Timid	Neutral	Confident	Totally Fearless

Does this cat enjoy playing with toys?(Required)

Yes

What type of toys?

HISTORY WITH OTHER ANIMALS & CHILDREN

Has this cat ever lived with other cats?(Required)

Yes

How would you describe their interactions with other cats?(Required)

Peacefully coexisted

Tolerated each other

Cannot live with others

Has this cat ever lived with dogs?(Required)

Yes

How would you describe their interactions with dogs?(Required)

Peacefully coexisted

Avoided each other

Dog chases cat

Has this cat ever lived with children?(Required)

Yes

What ages were the children?(Required)

0-5 years

6-12 years

13-18 years

DIETARY HABITS

It is not uncommon for cats to stop eating when stressed. Knowing what food and treats they enjoy is very helpful to staff and adopters!

What brand of food is this cat currently eating?(Required)

What other brands have they eaten in the past?(Required)

What type of food does this cat usually eat?(Required)

Dry food only

Canned food only

Combination of both

How often does this cat usually eat?(Required)

Free feed

Once a day

Twice a day

What types of treats does this cat enjoy?

MEDICAL HISTORY

Does this cat have a regular veterinarian?(Required)

Yes

Please list name of vet clinic:(Required)

Does this cat have any past or present medical conditions?(Required)

Yes

Please describe the medical condition(s):(Required)

Does this cat require any special food or medications?(Required)

Yes

Please describe special food or medication(s):(Required)

LITTERBOX HABITS

Where does this cat normally live?(Required)

Indoor

Outdoor

Both

Do they have access to a litterbox in the house?(Required)

Yes

Do they regularly use the litterbox?(Required)

Yes

Sometimes

How often does the cat make mistakes?(Required)

Please describe the accidents(Required)

Urinating on clothing / furniture

Urinating outside of litterbox

Spraying walls / furniture

Defecating outside of litterbox

Other

select all that apply

Describe the accident(Required)

How often is their litterbox cleaned?(Required)

Daily

Weekly

Monthly

Did a majority of accidents occur when the box was dirty?(Required)

Yes

Where was their litterbox located?(Required)

What type of litter was used?(Required)

Unscented

Scented

Clumping

Non-clumping

Crystals

Pine

Paper

How many cats share a litterbox?(Required)

Have there been any major life changes that could be the cause of these undesirable litterbox behaviors? Examples can include moving, a new baby, new pet, etc.(Required)

Yes

N/A

Has this cat been to a vet to rule out underlying health issues?(Required)

Yes

N/A

What was the conclusion?(Required)

ADDITIONAL INFORMATION

Please feel free to tell us any other information about this cat that you think might be helpful for our staff or their new family to know! Likes, dislikes, personality quirks, etc

DOG SURRENDER FORM

Dog's Name(Required)

Breed(Required)

Age(Required)

Weight(Required)

Is this dog spayed or neutered?(Required)

Yes

Sex(Required)

Female

Male

Is this dog microchipped?(Required)

Yes

Is the microchip registered to you?(Required)

Yes

Please provide the microchip number

GENERAL HISTORY

Why are you surrendering this dog? Please be as detailed as possible!(Required)

How long have you had this dog?(Required)

Including yours, how many homes has this dog had?(Required)

If this dog was adopted from another rescue or shelter, please list them here:

If this dog was adopted from the SAHS, please provide their animal ID:

PERSONALITY AND BEHAVIOR

Describe this dog's energy level(Required)

Couch Potato	Low Energy	Neutral	Active	Marathon Runner

Describe this dog's social personality(Required)

Very Independent	Independent	Neutral	Social	Social Butterfly

Describe this dog's affection level(Required)

Reserved	Somewhat Reserved	Neutral	Somewhat Loving	Cuddlebug

Describe this dog's fear level(Required)

Very Timid	Timid	Neutral	Confident	Totally Fearless

Would you describe this dog as loud?(Required)

Yes

Does this dog enjoy playing with toys?(Required)

Yes

What types of toys?

What type of behavior does this dog show when playing?(Required)

Jumping

Growling

Barking

Nipping

Light biting

Hard bitting

select all that apply

Is this dog allowed on the furniture?(Required)

Yes

What commands does this dog know?(Required)

Sit

Stay

Down

Come

Heel

Shake/Give paw

Other

Other:

Has this dog attended any training classes?(Required)

Yes

Does this dog know how to walk on a leash?(Required)

Yes

How many hours a day is this dog usually left alone?(Required)

0-3 Hours

4-8 Hours

9-12 Hours

Over 12 Hours

When this dog is left alone, do they show any of the following behaviors?(Required)

Chewing

Urinating/Defecating in Home

Barking / Crying / Whining

None

Would you consider this dog to be housebroken?(Required)

Yes

Does this dog go outside or using a pee pad / paper?(Required)

Outside

Paper/ Pee Pad

Where does this dog spend most of their time during the day?(Required)

Kenneled in house

Confined to a room in house

Roams free in house

Outside tied in yard

Outside confined by fence

Loose in neighborhood

Where does this dog normally sleep overnight?(Required)

Outside

Dog Bed

Owner's Bed

Kenneled Inside

Would you consider this dog to be an escape artist?(Required)

Yes

Has this dog escaped your property more than twice in the past 6 weeks? If so, please describe how:

To your knowledge, has this dog ever attacked another animal (dog, cat, livestock, etc.) resulting in severe injury or death?(Required)

Yes

Please explain in detail the incident:(Required)

To your knowledge, has this dog ever attacked or bitten a person?(Required)

Yes

Please explain the incident in detail

HISTORY WITH OTHER ANIMALS & CHILDREN

Has this dog ever lived with other dogs?(Required)

Yes

How would you describe their interactions with other dogs?(Required)

Peacefully coexisted

Tolerated each other

Cannot live with others

Has this dog ever lived with cats?(Required)

Yes

How would you describe their interactions with cats?(Required)

Peacefully coexisted

Avoided each other

Dog chases cat

Has this dog ever lived with children?(Required)

Yes

What ages were the children?(Required)

0 – 5 Years

6 – 12 Years

13 – 18 Years

MEDICAL HISTORY

Does this dog have a regular veterinarian?(Required)

Yes

Please list name of vet clinic

Does this dog have any past or present medical conditions?(Required)

Yes

Please describe the medical condition(s)(Required)

Does this dog require any special food or medications?(Required)

Yes

Please describe the special food or medications(Required)

DIETARY HABITS

It is not uncommon for dogs to stop eating when stressed. Knowing what food and treats they enjoy is very helpful to staff and adopters!

What brand of food is this dog currently eating?(Required)

What other brands have they eaten in the past?(Required)

What type of food does this dog usually eat?(Required)

Dry food only

Canned food only

Combination of both

How often does this dog usually eat?(Required)

Free fed

Once a day

Twice a day

What types of treats does this dog enjoy?

ADDITIONAL INFORMATION

Please feel free to tell us any other information about this dog that you think might be helpful for our staff or their new family to know! Likes, dislikes, personality quirks, etc.

Pet Surrender Form

SAN ANTONIO HUMANE SOCIETY SURRENDER AGREEMENT

CAT SURRENDER FORM

General History

Personality and Behavior

HISTORY WITH OTHER ANIMALS & CHILDREN

DIETARY HABITS

MEDICAL HISTORY

LITTERBOX HABITS

ADDITIONAL INFORMATION

DOG SURRENDER FORM

GENERAL HISTORY

PERSONALITY AND BEHAVIOR

HISTORY WITH OTHER ANIMALS & CHILDREN

MEDICAL HISTORY

DIETARY HABITS

ADDITIONAL INFORMATION

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