R.A.C.E. Rescue Animals Community Effort Surrender Form
We at R.A.C.E. Inc. understand that uncontrollable circumstances arise that make it difficult sometimes to properly care for or safely keep a pet in your home. Thank you for caring about the welfare and happiness of this animal.

Completing this form does NOT commit R.A.C.E. Inc. to taking said animal.

If you change your mind prior to R.A.C.E. contacting you, simply let our representative know when you are contacted.

Email address *
Your Full Name *
Your answer
Your Driver's License Number & State or Identification Card Number & State (example: NC - 018375978) *
Your answer
Your Address *
Your answer
City, State ZIP *
Your answer
Cell Phone Number
Your answer
Home Phone Number *
Your answer
Work Phone Number
Your answer
Type of Animal *
Required
Breed *
Your answer
Name of Animal
Your answer
Color of Animal *
Your answer
Approximate Age *
Your answer
Male or Female? *
Is Animal Spayed or Neutered? *
Where did you get the animal? *
Your answer
How long have you had the animal? *
Your answer
Can you provide veterinary records? *
Are you able to send current veterinarian records? If so, please send to racerescue@atmc.net *
Veterinarian Name *
Your answer
Veterinarian Phone Number *
Your answer
Describe any current and past health issues, injuries and/or special needs. *
Your answer
What brand and flavor of food do you feed? *
Your answer
Does the animal play with toys? If so what are favorites? *
Your answer
The animal lives with: *
Required
How is this animal around children? *
Required
How is this animal around Dogs? *
Required
How is this animal around Cats? *
Required
How is this animal around Livestock? *
Required
Your household is: *
Required
Activity level of the animal is: *
The animal has been kept: *
Required
How is the animal confined?
Your answer
Has the animal ever bitten? *
Required
Is this animal house trained? *
Why are you surrendering this animal? *
Your answer
By typing my full name below, I certify that I am the legal guardian (owner) of said animal and have complete authority to surrender said animal to R.A.C.E. Inc. I hereby release possession, title and any claims to said animal to R.A.C.E. Inc. and it's representatives and I certify that I will not make any attempt to reclaim said animal at any point in the future. I understand that R.A.C.E. Inc. reserves the right to refuse to accept any animal at the representative's sole discretion. *
Your answer
By typing my full name below, I understand and accept the terms that R.A.C.E. Inc. does agree to take puppies and kittens upon condition that ALL animals that continue under my possession will be spayed or neutered at no cost to me.
Your answer
Donations are encouraged to offset expenses incurred in the rehabilitation and care of animals before placement in a new home.
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