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Owner Surrender Request Form Template

Streamline the Pet Surrender Process with Ease

Feeling overwhelmed by the process of accepting pet surrenders? This Owner Surrender Request Form Template is designed to help animal shelters, rescue organizations, and veterinary clinics efficiently manage and document pet surrenders. With this user-friendly form, you can collect essential information, maintain accurate records, and enhance communication with pet owners, ensuring a smoother transition for animals in need. Plus, it's compliant with WCAG standards for accessibility. Explore how this template can simplify your process and improve outcomes for pets in your care.

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Full name
Email
Phone number
Address
Preferred contact method
Email
Phone call
Text message
No preference
Best time to contact you
Morning
Afternoon
Evening
Any time
Pet name
Species
Dog
Cat
Rabbit
Small animal
Bird
Reptile
Other
Please Specify:
Breed or mix (if known)
Approximate age
Sex
Male
Female
Unknown
Spayed or neutered
Yes
No
Approximate weight
Primary color/markings
Microchipped
Yes
No
Microchip number (if applicable)
How long have you owned this pet?
Where did you acquire this pet?
Shelter/Rescue
Breeder
Pet store
Friend/Family
Found/Stray
Born in my care
Other
Please Specify:
House-trained or litter box trained
Yes
Partially
No
Not applicable
Typical energy level
Very low
Low
Moderate
High
Very high
Has the pet shown aggression toward people?
Yes
No
Not sure
Has the pet shown aggression toward other animals?
Yes
No
Not sure
Has the pet ever bitten a person hard enough to break skin or require medical care?
Yes
No
Not sure
How does your pet do with children?
Good
Mixed/unsure
Not good
Not exposed
How does your pet do with dogs?
Good
Mixed/unsure
Not good
Not exposed
Please describe any known triggers, fears, or situations that cause stress
How does your pet do with cats?
Good
Mixed/unsure
Not good
Not exposed
Primary veterinarian or clinic name (if any)
Date of last veterinary visit (if known)
Are core vaccinations up to date?
Yes
No
Not sure
Known medical conditions or special needs
Current medications or treatments
Has the pet been around other animals in the last 14 days?
Yes
No
Not sure
Can you provide medical/vaccination records at surrender?
Yes
No
Not sure
Primary reason for surrender
Please Specify:
Please share any details that would help us understand your situation
How urgent is your request?
Within 24-48 hours
Within 1 week
Within 2-4 weeks
Flexible
Preferred surrender date
Can you keep the pet until an appointment is available?
Yes
No
Are you open to resources that might help you keep your pet (training, food, veterinary assistance)?
Yes
No
Are you the legal owner of this pet?
Yes
No
Do all household members consent to this surrender request?
Yes
No
I understand this request does not guarantee intake and that appointments, assessments, and fees may apply.
Yes
No
Type your full legal name as signature
Date signed
I confirm the information provided is accurate to the best of my knowledge.
Yes
No
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Paper art illustration depicting an owner surrender request form for FormCreatorAI article

When to use this form

Use this form when you need to transfer legal ownership of a dog, cat, or other small animal to a shelter, rescue, or municipal agency. It is helpful if you are moving to housing that bans pets, facing medical or financial hardship, dealing with unsafe behavior around kids, or taking in a found animal that is not yours. Teams use your details to triage, treat, and place animals faster and more safely. If the issue is an unfixed pet or an accidental litter, you might solve it with a Spay/neuter request form. If you are trying to report or reunite a stray, use the Lost and found pet form instead. Intake teams can pair this with a Veterinary intake form to capture vaccines, diet, and medication history for a smoother transition.

Must Ask Owner Surrender Request Questions

  1. What is your primary reason for surrendering this pet, and what steps have you already tried?

    Your answer helps us assess risk, suggest resources, and decide if rehoming or retention support is possible. Specifics reduce back-and-forth and speed up the right next step.

  2. What are the pet's species, breed, age, sex, weight, and microchip number (if any)?

    These details confirm identity and guide housing, feeding, and matching. Microchip info also helps us check for registration and reunification options.

  3. Which veterinarian has treated this pet, and may we request medical records?

    Medical history and consent let us provide safe care and avoid duplicate vaccines or procedures. With your permission, we can request records using the Veterinary EMR form.

  4. Has this pet ever bitten or seriously scratched a person or animal? If yes, list dates, circumstances, and any quarantine.

    Bite history affects legal reporting, rabies protocols, and placement decisions. Clear context helps us build safe handling plans or seek behavior support.

  5. What is your timeline for surrender, and can you keep the pet temporarily if needed? Do you consent to transfer ownership at intake?

    Timing and capacity planning depend on urgency and your ability to hold the pet. Consent for transfer avoids disputes and lets us begin care immediately upon intake.

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