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Cat or Dog?
Do you have any previous vet records?
Do you hav any medical concerns with this animal?
Do you hav any behavioral concerns with this animal?

Disclaimer and Signature

I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Animal Surrender Form. I hereby surrender any and all property rights to the animal. I certify that no other person has a right of property to the animal. I understand that by surrendering my property rights to the animal, the animal may be transferred into the custody of an animal shelter. I also hereby certify that the animal has/has not [circle one] bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and understand the terms of this Animal Surrender Form.


The transfer of property rights to the animal will take place on the day the animal is physically surrendered to a staff member or volunteer at Smiley’s Rescues. By signing below you agree from the time the animal is in the custody of a staff or volunteer from Smiley’s Rescues, that animal is Smiley’s Rescues property. As such, you relinquish all rights to that animal, including but not limited to decisions about medical care and foster/adoption placement.


Signing and sending in this application does NOT mean you are approved to surrender the animal. That decision takes place after a discussion with the director. After filling out this form you may or may not be approved for surrendering the animal. The date of surrender depends on space available at Smiley’s Rescues.

Thanks for submitting! We will call you within 24 hours.

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