Surrender Form for We Care Animal Rescue

Name of Animal:*

Approximate Weight:

Approximate Age (years/months/weeks)*

Male or Female*

Is the cat/kitten*

Spayed/Neutered*

If yes, date of spay/neuter:

Please select one of the following:*

Your Name*

First Last

Address*

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

Home Phone*

E-mail Address

Any previous vet care? If yes, please provide the name of vet and services.

Why are you surrendering this animal?*

Is this animal up to date on vaccines/yearly exams?*

Does this animal have any special needs or require medication?*

Is this animal friendly and able to be handled?*

Does this animal get along with other animals?*

Does anyone else have ownership rights to this animal?*

Do you own any other animals and what kind?*

If a stray, where and when was this animal found?

Have you placed an ad looking for this owner?

If previously adopted from a shelter or rescue, please provide the name of organization and date of adoption.

Has this animal bitten anyone in the last 10 days?*

Signature and date*

By signing this form, you relinquish all ownership rights to this animal and the animal becomes property of We Care Animal Rescue.

Signature and date

I also verify that this animal is up to date on vaccinations and that I can provide medical/vet records, which is required by We Care Animal Rescue to go forward with a surrender. By leaving this blank, you are stating the animal is not vaccinated or does not have medical records.

Consent*

I understand the animal will not be returned to me.

Consent*

I hereby surrender the above described animal to We Care Animal Rescue. Upon surrender of this animal, I release any claim on this animal and relinquish all rights with respect to the animal.

We collect demographic information to assist us when applying for grants. If you would like to participate, please fill out the following survey.

What is your age?

18-24
25-34
34-44
45-54
over 54

Which gender do you most identify with?

Male
Female
Transgender
Other

What best describes your ethnicity (select all that apply)?

Latino or Hispanic
African-American
Asian
Native American
Pacific Islander
Caucasian
Other
Prefer not to say

What is your marital status?

Married
Domestic Partnership
Divorced
Separated
Widowed
Unmarried/Never married

Surrender Form for We Care Animal Rescue

Cat Surrender Form

We collect demographic information to assist us when applying for grants. If you would like to participate, please fill out the following survey.