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1
Wise Animal Rescue Surrender Application
Owner's Information
First Name
Last Name
Date of Birth
Street Address
City
State
Zip Code
Home Phone #
Cell Phone #
Work Phone #
Are you the owner of the animal
If no, where is the owner and do you have possession of the animal?
Pet's Information
Pet's Name
Nickname
Breed
Spayed/Neuteredpick one!
Age
Date of Birth
Pet's History
How long has this pet lived with you?use slider to make selection
1yrs
0
10+yrs
Where did you obtain the pet?
If from a breeder or rescue group, did you contact them before surrendering your pet here?
Why are you surrendering your pet?
Please explain why you are surrendering your pet
0 /
Who is your current veterinarian?please include name and contact information
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Is your pet current on his/her rabies vaccination?pick one!
Is your pet current on his/her distemper vaccination?pick one!
Date of last rabies vaccination
date_range
Date of last distemper vaccination
date_range
Does your pet have any current health issues?pick one!
Please explain current health issues
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Does your pet have any past health issues?pick one!
Please explain past health issues
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Pet's Behavior
When left alone, does your petselect all that apply
Is your pet crate-trained?pick one!
Is your pet housetrained?pick one!
How does your pet greet strangers?
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How does your pet greet other animals outside of the home or in general?
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Has your pet had any experience with children?pick one!
Would you recommend your pet be placed in a home with children?pick one!
Please explain why you would (not) recommend home with children
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Has your pet ever bitten or nipped you or anyone else?pick one!
Did the bite(s) break skin?pick one!
Were there stitiches?pick one!
Please explain details of bite
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Has your pet lived with other animals?pick one!
Please list species, ages, sizes of other animals
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Has your pet ever fought with another animal?pick one!
Please explain
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Are there areas on your dog's body that he/she does NOT like to be touched?select all that apply
Please explain other
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If touched in the above place(s), how does your pet respond?select all that apply
Please tell us about your pet's "bad habits" or fears(i.e. chewing shoes, jumping on counters or people, hiding during thunderstorms, fireworks, etc)
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Is there anything specific to your pet that you would like to share to make the transition easier
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What is your pet's potty schedule
0 /
What is your pet's meal schedule
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Where does your pet sleep? Describe sleeping habits...
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Describe the ideal home for your pet
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Have you consulted with a professional trainer about your pet?pick one!
Other
Do you understand that once you surrender your pet he/she becomes property of Wise Animal Rescue?pick one!
Do you understand you will not get your pet back after he/she is surrendered?pick one!
Do you understand that you will be expected to make a monetary donation to help care for your pet once surrendered?pick one!

Please be aware that once a pet is surrendered it becomes the property of Wise Animal Rescue. 
Certain unforeseen circumstances may warrant euthanasia

By hitting SUBMIT APPLICATION, I certify that the above information is true and accurate to the best of my knowledge and I understand that my completion of this form in no way obligates Wise Animal Rescue to accept my dog into the rescue. By submitting this application, I authorize Wise Animal Rescue to contact my veterinarian and anyone else listed.veterinarian and contact anyone listed.

Commentsmore details
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