Animal Surrender Form

1
Name/Names:* This field is required.
2
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Phone Number* This field is required.
Area Code
Phone Number
4
Email* This field is required.
example@example.com
5
Date:* This field is required.
Date
Month
Day
Year
6
Animals Name:* This field is required.
7
Age
8
Breed* This field is required.
9
Upload a picture of your Animal(s).* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
10
Check the corresponding boxes to inform ASAP Animal Rescue Behavior Specialist's as to whether or not your pet has any behavioral concerns worth noting or working on with a professional trainer while in shelter or in foster. Any items marked Yes will be worked on with a trainer. Any items marked Maybe will be evaluated. Please use the back of this sheet to elaborate on any items which you think require additional information
11
Is your animal an escape artist?* This field is required.
Yes
No
Unknown
12
Does your animal struggle to be confined (in a crate)?* This field is required.
Yes
No
Unknown
13
Is your animal reactive to seeing dogs or people when on leash?* This field is required.
Yes
No
Unknown
14
Is your Animal destructive in the home?* This field is required.
Yes
No
Unknown
15
Does your animal get anxious in the car/carsick?* This field is required.
Yes
No
Unknown
16
Is your animal house trained/potty trained?* This field is required.
Yes
No
Unknown
17
Is your Animal protective of their food?* This field is required.
Yes
No
Unknown
18
Is your animal protective of their toys?* This field is required.
Yes
No
Unknown
19
Is your animal protective of their bed/space?* This field is required.
Yes
No
Unknown
20
Is your animal protective of their siblings (if any)?* This field is required.
Yes
No
Unknown
21
Is your animal protective of their handler?* This field is required.
Yes
No
Unknown
22
Is your animal okay with children 0-5?* This field is required.
Yes
No
Unknown
23
Is your animal okay with children 5+ (including teens)?* This field is required.
Yes
No
Unknown
24
Has your animal ever lived with other animals?* This field is required.
Yes
No
Unknown
25
If yes, What type of animal coexisted with yours?* This field is required.If no, put unknown
cats
Dogs
Unknown
Other
26
Any specifics on your animals behavior towards other animals?* This field is required.
Yes
No
Unknown
27
Has your animal ever inured another animal?* This field is required.
Yes (provide detail)
No
Unknown
28
Has your animal been fearful of children?* This field is required.
Yes
No
Unknown
29
Has your animal been fearful of men?* This field is required.
Yes
No
Uknown
30
Is your animal fearful of women?* This field is required.
Yes
No
Uknown
31
Does your animal enjoy playing with toys?* This field is required.
Yes
No
Unknown
32
What type of food and how often do you feed your animal a day?
33
Has your animal enjoyed treats?* This field is required.
Yes
No
Unknown
34
Has your animal ever injured a person?* This field is required.
Yes (explain)
No
Unknown
35
Up to date on all preventative?Vaccinations, dewormer, flea/tic treatment, spay/neuter
YESNO
36
Is your animal up to date on all medical?ASAP animal rescue asks that your animal come to us up to date on vaccines, spay/neuter
YESNO
37
Notes/Reason for Surrender* This field is required.
38
Add any medical history if possible We ask that you surrender your animal is healthy and up to date on all vaccinations and medical care.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
If there is none, please make an appointment with your vet or clinic to get a check up and everyhting that is needed before coming to ASAP. coming to AS
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39
Relinquishing Receipt for Animal Surrendered to ASAP Animal Rescue by Owner* This field is required.
I hereby give ASAP Animal rescue permission to request all medical history and medical records from my Veterinarian for the animal i am relinquishing.
40
Signature* This field is required.
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