Surrender Request Form
firstname.lastname@example.org • PO Box 1012 Alva FL 33920
Please keep in mind this is a request form that will be evaluated by a rescue representative. If we have an available foster and funds to take in your pet, we will contact you to complete the surrender process - THIS SURRENDER REQUEST FORM IS NOT A GUARANTEE WE CAN TAKE IN YOUR PET. If you found a lost or stray animal, by law we are not allowed to take it in and it must be processed through Lee County Domestic animal Services (more information here: leegov.com/animalservices/foundpet). If found outside of Lee County, research and contact animal services for the area the animal was found.
Owner Mobile Phone Number
Please write the 1) name, 2) breed(s) 3) age, and 6) sex of the dog(s).
How did you get the dog(s) and how long did you have it for?
Please list Animal(s) that you would like to surrender:
Are your dog(s) spayed/neutered?
Do you have proof of vaccines?
Yes - my dogs are vaccinated and I DO have vet records
Yes - my dogs are vaccinated but I DO NOT have vet records
No - my dog is NOT VACCINATED
Is the dog good with
NONE - MUST BE THE ONLY PET
Owner's Reason for Surrender
List any medication(s) or allergies for the above mentioned pet(s):
List any particular concerns or things the rescue should know about the animal(s) - good and not so good:
Attach any photo(s) you have of the dog
Vet's Name & Address
District of Columbia
Vet's Phone Number
Do we have permission to contact your vet and ask questions about the pet(s) above?
The animal(s) I am doing a Surrender Request Form stated above are my own animals and are not lost/strays I have found
I have read and understand the above statement - the animal(s) on this form are not lost or stray animals
Submit Surrender Request Form
Should be Empty: