Surrender Inquiry : Hope Animal Rescue of Iowa

Please complete the surrender form so we can assess if we have availability at this time or in the near future for your inquiry. Hope Animal Rescue is foster-based, so a foster has to be available for the animal to be considered for surrender. Information is needed for this determination and other Rescue considerations. Once the initial form is submitted, an additional form may be requested with more detailed information, as unfortunately, we do not have the capacity to assist all requests that are received.

*Your Name

*Email Address

*Address

*City

*State

*Species of Animal Needing to Surrender:

Dog?puppy Cat/Kitten

*Postal

Phone

*Name of Animal

Age of Animal:

*Animal Gender

Male Female

*Breed(s) of Animal (to the best of your knowledge):

*How did you aquire this animal:

*If any medical concerns, please explain:

If any behavioral concerns? Please explain including professional trainers/behaviorist you have used

*Does the animal have a bite history?

Yes No

*Is the animal potty/house/litter trained?

Yes No

*Do you have veterinary records?

Yes No

*Veterinarian Name

*Veterinarian Phone Number

*Is the Animal Spayed/Neutered?

Yes No

*Is the animal crate trained?

Yes No

*Please list if the pet is up-to-date (UTD) on the following vaccinations -- must have vet records as proof to check:

Rabies Distemper Bordatella Not up to date

If Cat/Kitten - are they declawed?

Yes - all 4 feet Yes - front only No

If cat/kitten is it FELV/FIV Positive? Must have vet records for Yes or No

Yes No Unknown (no vet records available)

*Is the animal good with kids?

Yes No

*Does your animal get along with dogs?

Yes No

*Does the animal get along with cats?

Yes No

How long have you had your pet?

Are you able to pay a $150 surrender fee?

Yes No

*Please explain why you are needing to surrender your pet?

*How soon must the animal be moved?

*How did you hear about Hope Animal Rescue of Iowa?

*I agree the above info is true to the best of my knowledge and I am the legal owner of the animal giving up all rights to the animal. If Hope Animal Rescue agrees to accept the animal into our Rescue and the animal does NOT fit the description above, Hope Animal Rescue has the right to DECLINE surrender at that time. This Surrender Inquiry is NOT commitment that Hope Animal Rescue will accept the animal, only information to determine if Hope Animal Rescue has capacity as Hope Animal Rescue does NOT have capacity to assist all requests that are received as Hope Animal Rescue has only temporary homes (no shelter).

I Agree that I am the owner of such animal; I am prepared to relinquish all rights to the animal; and I understand that Hope Animal Rescue can deny any request for any reason.