Little Orphan Angels Animal Surrender Form

 

Animal's Name:
Your Name:
Address:
City:
State:	Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota North West Territory Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Is. Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Home Phone:
email (required):
Animal type:	Dog Cat
Sex:	Male Female
Breed:
Has this animal been spay/neutered?	Yes No Unsure
Is this animal current on vaccinations?	Yes No Unsure
If yes, when is it due for vaccinations?
What percentage of the time does this animal spend indoors?	100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside
Is the animal litter/potty trained?	Yes No Unsure
How would you describe this animal's personality?  (please check all that apply)	Single pet   Friendly  Outgoing Demanding	Easygoing Playful   Quiet   Aloof	Finicky    Fickle   Active  Unpredictable	Skitish Shy   Uncontrollable
How did you find Little Orphan Angels?	PetFinder.com Vet referral Previous Adopter PetsMart
If this animal was a stray, have you contacted your city's Animal Control and taken the proper steps?	Yes No
Why are you attempting to put this animal up for adoption?
Please provide any additional details of your animal's behavior/personaility:
If this is a cat, is it declawed?	Yes No
Who is your current Veterinarian/Clinic:
Veterinarian Telephone:
What is the animal eating?
Has this animal been diagnosed with any of the following diseases?	CATS Feline Leukemia  Feline Urological Syndrome Feline Infectious Peritonitis Feline Immunedeficient Virus		DOGS Heartworm Disease Corona Virus Distemper/Parvo Kennel Cough
Please provide us with any additional details that may help us evaluate your application.
Little Orphan Angels is a non-profit organization and needs your help to provide rescue and foster services.  We appreciate your tax-deductible donation which will be used towards the care and feeding of this and other stray animals.  Please be as generous as possible.  Thanks!	Donation Amount:

I’m in complete understanding that by submitting this from, I am surrendering my animal to Little Orphan Angels for adoption. I certify that I am the owner or I have authority to surrender the animal described above. It is understood that Little Orphan Angels will not be obligated to account for the disposition of the animal.   I understand that any misrepresentation of this animal‘s medical history, conditions or behavior can result in Little Orphan Angels returning the animal to me and I would be obligated to reimburse Little Orphan Angels for all medical costs or the adoption fee, whichever is higher.

Little Orphan Angels Animal Rescue & Adoption Agency

1205 N. Saginaw Blvd #D, PMB 205, Saginaw, TX 76179 

(817) 741-2386 ۰ Fax: (817) 741-2385

A  nonprofit, tax-exempt organization

©Copy Right Little Orphan Angels Animal Rescue & Adoption Agency 2010