Surrender Application Form

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Owner Information

Name

First Last

Phone Number

Cell Phone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How did you hear about us?

Would you be willing to speak with a trainer to try and fix this situation so you could keep your pet?

Trainers generously donate their time and expertise for these calls. The surrender form must still be completed, but please check the “Yes, I’d like to speak with a trainer” box below

Are you able to provide a monetary donation upon surrender of your pet and/or provide monthly monetary donations while your pet is in our care? Please provide details:

FileUpload an image of your pet

Drop files here or

Max. file size: 900 MB.

Name

First Last

Pet's Information

Pet's Name

Sex of Pet

Is the Pet Neutered/Spayed?

Is the Pet Microchipped?

If yes, please provide the number

Pet's Breed

Pet's Age

Pet's Weight

Where did you get your pet?

How long have you had your pet?

Please describe the reason you need to surrender your pet?

Has your pet lived with dogs, cats, children? Please list and include gender and ages:

Does your pet show aggression towards adults, children, dogs, cats? Please list:

Does you pet have any behavioral issues? Please describe:

If Applying To Surrender A Dog, Please Complete This Section

Has your dog been tested for heartworm in the past year?

Is Your Dog Up To Date On Vaccines?

Rabies

Distemper/Parvo

Bordetella

Lepto

If you answered No or Unsure to any of the above, are you willing to provide the needed vaccinations/testing if your pet is accepted for residency at Satchel's?

Please describe any existing medical conditions:

What is the date of your pet's last vet visit?

Month

Day

Year

May we contact your vet to verify the information you have provided?

If Yes to above question, please provide vet's name and phone number:

Is your dog friendly when visitors come to your home?

How does your dog react when you pet them or approach them while eating, playing with a toy, or chewing on a treat?

If You Are Applying To Surrender A Cat, Please Complete This Section

Has your cat been tested for FIV and Feline Leukemia in the past year?

Is Your Cat Up To Date On Vaccines?

FVRCP for cats?

FeLV for cats?

Rabies?

Please describe any existing medical conditions:

What is the date of your pet's last vet visit?

Month

Day

Year

May we contact your vet to verify the information you have provided?

If Yes to above question, please provide vet's name and phone number:

Does your cat ever urinate or defecate outside the litter box?

If yes to the above question, please explain:

Section Break

I understand that submission of this application is a request on my pet’s behalf to be considered to be placed on Satchel’s Last Resort Animal Shelter/Sanctuary’s waitlist and does not constitute an acceptance of residency by Satchel’s Last Resort Animal Shelter/Sanctuary. We encourage you to continue to seek placement elsewhere.

I have read and understand

How long are you able to keep the pet in your home while searching for placement?

By submitting this application, I hereby acknowledge that I am the lawful owner of the animal I am seeking to surrender and I came into possession of this animal legally.

I have read and understand

By submitting this application, I hereby acknowledge that I am the lawful owner of the animal I am seeking to surrender and I came into possession of this animal legally.

Signature

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