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PAWS Pet Surrender Form
Pet Adoption & Wellness Services (hereinafter called PAWS) hereby accepts title of ownership to the animal herein described from its owner (hereinafter called Releaser) below, who relinquishes the animal. Please answer all questions. If a question does not apply to you, then please put N/A in that space.
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Relinquishing Owner's Name:
Your answer
Address:
Your answer
City:
Your answer
State:
Your answer
State:
Your answer
ZIP:
Your answer
Phone Number:
Your answer
Email Address:
Your answer
Name of Pet:
Your answer
Type of Pet:
Dog
Cat
Other:
Clear selection
Breed of Pet:
Your answer
11. Age of Pet:
Your answer
Gender of Pet:
Male
Female
Clear selection
Is the pet spayed or neutered?
Yes
No
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Describe the pet's color/markings:
Your answer
How long have you had the pet?
Your answer
When and where did you get this pet?
Your answer
Is the pet currently under veterinary care?
Yes
No
Clear selection
Do you have the pet's veterinary records?
Yes
No
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19. Is the pet currently on any medication?
Yes
No
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If yes, please list the medications:
Your answer
Do you know of any medical or behavioral problems?
Yes
No
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If yes, please explain:
Your answer
Current Veterinarian's Name, Address, and Phone Number:
Your answer
Why are you surrendering your pet?
Your answer
By checking this box and submitting this form, I agree that the information provided above is true, complete, and accurate to the best of my knowledge.
I agree
Date:
MM
/
DD
/
YYYY
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