Owner Surrender Form

PET'S NAME *

Brief description of the breed, color, size and markings of the pet you wish to surrender. *

YOUR LEGAL NAME *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please provide the reason for surrendering your pet. *

How did you aquire this pet?

If this pet was a stray did you exhaust all legal options to locate possible owner as a lost pet? Did you have the pet scanned for a chip? Did you notify local shelters? Did you make either a newspaper posting or online social media post indicting you had the pet? Did you hold the pet for at least 10 days while making all attempts to locate possible owner? If this was not a stray simply note NA in the field *

If this pet was adopted from a shelter, a rescue or repuatable breeder did you read your contract to verify if you must return the pet to the source it was purchased or adopted from? If this was not adopted or purchased simply note NA in the field. *

Dog or Puppy(ies) *

Spay or Neutered *

How long have you had this pet? *

Crate Trained? *

Medical Issues? *

Behavorial Concerns? *

Flea/tick preventives? *

Annual vaccines current? *

Male or Female *

Age or Date of Birth *

Provide Microchip Number *

House Trained? *

Medications Required? *

Heartworm preventives? *

Heartworm test date and result? *

Rabies date? *

Socialized with children? *

How would you describe the dogs reaction to children, teenagers or strangers

Socialized with cats *

How would you describe the dogs reaction to cats?

Socialized with dogs? *

How would you describe the dogs reaction to other dogs?

Are there any behavior issues we need to be aware of? Please elaborate and be very specific and honest. This information is extremely important to allow us to be transparent with potential adopters and ensure a sucessful transition into their new home with a new family. PLEASE NOTE, if you withhold information about any aggression or biting or (snipping) behaviors, you can be held accountable if the dog displays any of these behaviors in it's new home resulting in injury to human, other pets or property.

Please provide the current Veterinarian name and contact information

Attach all vaccine and vetting records here

Click or drag files to this area to upload. You can upload up to 10 files.

Any additional information you would like to provide?

By singing this form, you contest that all information you have provided is true to the best of your knowledge. You also certify that you are the legal guardian/owner of this animal and that you are legally entitled to transfer owership to Pet Path. By signing this form you understand that you are permanently and irrevocably transfering ownership of this animal, with all rights, to Pet Path. You agree to transfer the microchip owership information to Pet Path immediately. By signing this form you also acknolwedge that failure to provide any behavioral issues or concerns to Pet Path, can result in leagal action against you should the animal cause injury to a person, another animal or personal property.

Clear Signature