Surrender Application

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Breed/Species/Gender of Animal:

Age of Animal:

Reason for Surrender:

How long have you owned this animal?

Are you wanting to be added to the waitlist if we don't have immediate room?

Do you have vet records for this animal?

What sort of timeline are we looking at for this animal needing to be surrendered?

Is this animal spayed/neutered?

Is this animal UTD on a wellness exam/Vaccinations?

Has this animal been around cats?

Has this animal been around dogs?

Has this animal been around children? If yes, what age?

Do you have medical concerns with this animal?

If this is a dog, has the dog ever been in a crate? If cat, answer NA.

If dog, how does this dog do with recall/do you trust them outside alone once comfortable? If cat, answer NA.

Do you see food aggression with this dog? If cat, answer NA.

If this is a cat, are they declawed? If dog, answer NA.

Where did you originally get this animal from?

What kind of food does this animal eat, and how much per day?

Please describe this animal's daily routine.

Has this animal bit anyone is the last 10 days?

I verify that everything listed in this application is true and correct.

Would you like to make a donation to support this animal's time in our care? If yes, please visit the donation tab on our website or you can donate in person. *Donations do not confirm that we can take this animal. *

Upload All Records here or email to sid@smileysrescues.com

Upload photo of animal here:

Upload video of animal here: If they are said to be cat, kid, or dog friendly, upload videos here of them interacting with the things described above.

Additional Videos

I am the current owner of this animal.

Signature

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