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APR 13-18 – SEMINAR: Tellington TTouch for Companion Animals
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OWNER SURRENDER FORM
OWNER SURRENDER FORM
OWNER SURRENDER
This form should be used by persons seeking to re-home their pets. We are aware this form is long and can seem intimidating. Please know that it is in the best interest of your pet to fill it out as completely as possible. This form can be used for multiple pets. Please fill out each section individually then select "yes" when asked if you have another pet to surrender. Maximum of 3 pets per form.
PLEASE NOTE:
The intake process requires a scheduled behavior/medical evaluation to be performed by a PAWS staff member for each animal before they are eligible for our adoption program.Thank you.
Date
*
Name
*
First
Last
Address
*
Physical addresses only.
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
*
Email
*
Why are you seeking to re-home this pet / these pets?
*
Please be as descriptive as possible. The more information provided, the better chance we have at finding a suitable home for this pet. Additionally, detailed information may expedite the surrender process.
Species:
*
Please choose one.
Dog
Cat
Pet's Name
Pet's Age
*
Please approximate if you are unsure.
Gender
*
Male
Female
Breed:
*
If the dog is a mixed breed, please list which breeds the dog most closely resembles.
Breed / Description
*
Please describe the coat patterns of the cat if no breed is obvious. (i.e. tabby, calico, etc.)
Color:
*
Please be descriptive.
Coat Length
*
Short
Medium
Long
Hairless
How long have you owned this pet?
*
Where did you originally get this pet?
*
Stray
Breeder
Animal Shelter
Friend / Neighbor
Other
Where did you originally get this pet?
Which shelter?
*
Austin Animal Center (FKA Town Lake Animal Center)
Austin Pets Alive!
Austin Humane Society
PAWS Shelter of Central Texas (FKA PAWS Shelter and Humane Society)
San Marcos Animal Shelter
Other
Which shelter?
***Austin Pets Alive! will take back any adopted pet if the adoption does not work out for any reason. Please e-mail adopt@austinpetsalive.org to start the return process. Please specify the problem you are having with your pet so they can assist you quickly. Contact cat-behavior@austinpetsalive.org or dogbehaviorfollowup@austinpetsalive.org if you are having behavior concerns that you hope to resolve.***
***If you adopted your pet from PAWS Shelter of Central Texas (FKA PAWS Shelter and Humane Society), you may return the pet immediately. Please email intake@pawsshelter.org for more details about returning your pet. You may also call 512-268-1611 and someone will return your call within 24 hours.***
This pet has been kept:
*
Mostly Indoors
Mostly Outdoors
Both - 50/50
Please upload a photo (or photos) of your pet.
Veterinary Information and Medical History:
Veterinarian(s) Information:
Please list all veterinarians (if applicable) that have seen this pet. Use the
to add more information.
Veterinarian or Clinic Name
Phone Number
Which vaccinations have been given to this pet?
DHPP / DHLPP
Bordatella
Rabies
DHPP / DHLPP Details:
Veterinarian or Clinic Name
Date of Vaccination
Bordatella Details:
Veterinarian or Clinic Name
Date of Vaccination
Rabies Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Which vaccinations have been given to this pet?
FVRCP
Feline Leukemia Vaccine
Rabies
FVRCP Details:
Veterinarian or Clinic
Date of Vaccination
Feline Leukemia Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Rabies Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Has this dog had a Heartworm test?
*
No
Yes
Unsure
Heartworm Test Details:
Veterinarian or Clinic Name
Date of Heartworm Test
What was the result of the Heartworm Test?
Negative
Positive
Unsure
Has this cat had a Feline Leukemia (FeLV) test?
*
No
Yes
Unsure
Feline Leukemia Test Details:
Veterinarian or Clinic Name
Date of FeLV Test
What was the result of the Feline Leukemia Test?
Negative
Positive
Unsure
Has this cat had a Feline Immunodeficiency Virus (FIV) test?
*
No
Yes
Unsure
Feline Immunodeficiency Virus (FIV) Test Details:
Veterinarian or Clinic Name
Date of FIV Test
What was the result of the FIV Test?
Negative
Positive
Unsure
Has this pet been spayed or neutered?
*
No
Yes
Unsure
Has this cat been declawed?
*
No
Yes
Unsure
Does this pet have any current or previous special or medical issues?
Medications, special diet, allergies, previous injuries, etc.
Behavior and Personality:
Please provide honest and detailed information. These answers provide us with important information that will allow us to find appropriate homes and are not necessarily used to determine eligibility.
What is this dog's personality like in general?
*
Please include energy level, quirks, likes and dislikes, anxiety or fear issues, etc.
Which best describes this cat's personality?
*
Please check all that apply.
Social Butterfly
Independent Loner
Ultra Confident
Grumpy Pants
Scaredy Cat
Wild and Mean
Additional personality details:
Please include energy level, quirks, likes and dislikes, anxiety or fear issues, etc.
This dog does NOT do well with:
*
Cats
Any Dogs
Certain Dogs
Any Children ( < 12 y.o.)
Certain Children
Certain People
Livestock
Unsure
N/A. This dog gets along with everything.
This cat does NOT do well with:
*
All Cats
Certain Cats
All Dogs
Certain Dogs
Unsure
N/A. This cat gets along with everything.
Please provide additional details about the dog's behavior with cats:
Please provide additional details about the dog's behavior with other dogs:
Please provide additional details about the types of dogs your dog does not do well with and their behavior toward them:
Please provide additional details about the dog's behavior around children:
Please provide additional details about the types of children this dog does not do well with and the behavior toward them:
Please provide additional details about the types of people this dog does not do well with and the behavior towards them:
Please provide additional details about the types of livestock this dog does not do well with and the behavior towards them:
Please provide additional details about this cat's behavior around other cats:
Please provide additional details about types of cats this cat does not do well with and their behavior toward them:
Please provide additional details about this cat's behavior around dogs:
Please provide additional details about types of dogs this cat does not do well with and their behavior toward them:
Perks:
This is just for extra information and bears no weight in the intake process. Please check all that apply:
Potty Trained
Knows Commands
Gentle on Leash
Crate Trained
Other
Which commands?
Other Perks:
Do you have another pet to surrender?
No
Yes
SECOND PET
Species:
*
Please choose one.
Dog
Cat
Pet's Name
Pet's Age
*
Please approximate if you are unsure.
Gender
*
Male
Female
Breed:
*
If the dog is a mixed breed, please list which breeds the dog most closely resembles.
Breed / Description
*
Please describe the coat patterns of the cat if no breed is obvious. (i.e. tabby, calico, etc.)
Color:
*
Please be descriptive.
Coat Length
*
Short
Medium
Long
Hairless
How long have you owned this pet?
*
Where did you originally get this pet?
*
Stray
Breeder
Animal Shelter
Friend / Neighbor
Other
Where did you originally get this pet?
Which shelter?
*
Austin Animal Center (FKA Town Lake Animal Center)
Austin Pets Alive!
Austin Humane Society
PAWS Shelter of Central Texas (FKA PAWS Shelter and Humane Society)
San Marcos Animal Shelter
Other
Which shelter?
***Austin Pets Alive! will take back any adopted pet if the adoption does not work out for any reason. Please e-mail adopt@austinpetsalive.org to start the return process. Please specify the problem you are having with your pet so they can assist you quickly. Contact cat-behavior@austinpetsalive.org or dogbehaviorfollowup@austinpetsalive.org if you are having behavior concerns that you hope to resolve.***
***If you adopted your pet from PAWS Shelter of Central Texas (FKA PAWS Shelter and Humane Society), you may return the pet immediately. Please email intake@pawsshelter.org for more details about returning your pet. You may also call 512-268-1611 and someone will return your call within 24 hours.***
This pet has been kept:
*
Mostly Indoors
Mostly Outdoors
Both - 50/50
Please upload a photo (or photos) of your pet.
Veterinary Information and Medical History:
Veterinarian(s) Information:
Please list all veterinarians (if applicable) that have seen this pet. Use the
to add more information.
Veterinarian or Clinic Name
Phone Number
Which vaccinations have been given to this pet?
DHPP / DHLPP
Bordatella
Rabies
DHPP / DHLPP Details:
Veterinarian or Clinic Name
Date of Vaccination
Bordatella Details:
Veterinarian or Clinic Name
Date of Vaccination
Rabies Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Which vaccinations have been given to this pet?
FVRCP
Feline Leukemia Vaccine
Rabies
FVRCP Details:
Veterinarian or Clinic Name
Date of Vaccination
Feline Leukemia Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Rabies Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Has this dog had a heartworm test?
*
No
Yes
Unsure
Heartworm Test Details:
Veterinarian or Clinic Name
Date of Heartworm Test
What was the result of the Heartworm Test?
Negative
Positive
Unsure
Has this cat had a Feline Leukemia (FeLV) test?
*
No
Yes
Unsure
Feline Leukemia Test Details:
Veterinarian or Clinic Name
Date of FeLV Test
What was the result of the Feline Leukemia Test?
Negative
Positive
Unsure
Has this cat had a Feline Immunodeficiency Virus (FIV) test?
*
No
Yes
Unsure
Feline Immunodeficiency Virus (FIV) Test Details:
Veterinarian or Clinic Name
Date of FIV Test
What was the result of the FIV Test?
Negative
Positive
Unsure
Has this pet been spayed or neutered?
*
No
Yes
Unsure
Has this cat been declawed?
*
No
Yes
Unsure
Does this pet have any current or previous special or medical issues?
Medications, special diet, allergies, previous injuries, etc.
Behavior and Personality:
Please provide honest and detailed information. These answers provide us with important information that will allow us to find appropriate homes and are not necessarily used to determine eligibility.
What is this dog's personality like in general?
*
Please include energy level, quirks, likes and dislikes, anxiety or fear issues, etc.
Which best describes this cat's personality?
*
Please check all that apply.
Social Butterfly
Independent Loner
Ultra Confident
Grumpy Pants
Scaredy Cat
Wild and Mean
Additional personality details:
Please include energy level, quirks, likes and dislikes, anxiety or fear issues, etc.
This dog does NOT do well with:
*
Cats
Any Dogs
Certain Dogs
Any Children ( < 12 y.o.)
Certain Children
Certain People
Livestock
Unsure
N/A. This dog gets along with everything.
This cat does NOT do well with:
*
All Cats
Certain Cats
All Dogs
Certain Dogs
Unsure
N/A. This cat gets along with everything.
Please provide additional details about the dog's behavior with cats:
Please provide additional details about the dog's behavior with other dogs:
Please provide additional details about the types of dogs your dog does not do well with and their behavior toward them:
Please provide additional details about the dog's behavior around children:
Please provide additional details about the types of children this dog does not do well with and the behavior toward them:
Please provide additional details about the types of people this dog does not do well with and the behavior towards them:
Please provide additional details about the types of livestock this dog does not do well with and the behavior towards them:
Please provide additional details about the cat's behavior around other cats:
Please provide additional details about the types of cats this cat does not do well with and the behavior towards them:
Please provide additional details about the cat's behavior around dogs:
Please provide additional details about the types of dogs this cat does not do well with and the behavior towards them:
Perks:
This is just for extra information and bears no weight in the intake process. Please check all that apply:
Potty Trained
Knows Commands
Gentle on Leash
Crate Trained
Other
Which commands?
Other Perks:
Do you have another pet to surrender?
No
Yes
THIRD PET
Species:
*
Dog
Cat
Pet's Name
Pet's Age
*
Please approximate if you are unsure.
Gender
*
Male
Female
Breed:
*
If the dog is a mixed breed, please list which breeds the dog most closely resembles.
Breed / Description
*
Please describe the coat patterns of the cat if no breed is obvious. (i.e. tabby, calico, etc.)
Color:
*
Please be descriptive.
Coat Length
*
Short
Medium
Long
Hairless
How long have you owned this pet?
*
Where did you originally get this pet?
*
Stray
Breeder
Animal Shelter
Friend / Neighbor
Other
Where did you originally get this pet?
Which shelter?
*
Austin Animal Center (FKA Town Lake Animal Center)
Austin Pets Alive!
Austin Humane Society
PAWS Shelter of Central Texas (FKA PAWS Shelter and Humane Society)
San Marcos Animal Shelter
Other
Which shelter?
***Austin Pets Alive! will take back any adopted pet if the adoption does not work out for any reason. Please e-mail adopt@austinpetsalive.org to start the return process. Please specify the problem you are having with your pet so they can assist you quickly. Contact cat-behavior@austinpetsalive.org or dogbehaviorfollowup@austinpetsalive.org if you are having behavior concerns that you hope to resolve.***
***If you adopted your pet from PAWS Shelter of Central Texas (FKA PAWS Shelter and Humane Society), you may return the pet immediately. Please email intake@pawsshelter.org for more details about returning your pet. You may also call 512-268-1611 and someone will return your call within 24 hours.***
This pet has been kept:
*
Mostly Indoors
Mostly Outdoors
Both - 50/50
Please upload a photo (or photos) of your pet.
Veterinary Information and Medical History:
Veterinarian(s) Information:
Please list all veterinarians (if applicable) that have seen this pet. Use the
to add more information.
Veterinarian or Clinic Name
Phone Number
Which vaccinations have been given to this pet?
DHPP / DHLPP
Bordatella
Rabies
DHPP / DHLPP Details:
Veterinarian or Clinic Name
Date of Vaccination
Bordatella Details:
Veterinarian or Clinic Name
Date of Vaccination
Rabies Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Which vaccinations have been given to this pet?
FVRCP
Feline Leukemia Vaccine
Rabies
FVRCP Details:
Veterinarian or Clinic Name
Date of Vaccination
Feline Leukemia Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Rabies Vaccine Details:
Veterinarian or Clinic Name
Date of Vaccination
Has this dog had a Heartworm test?
*
No
Yes
Unsure
Heartworm Test Details:
Veterinarian or Clinic Name
Date of Heartworm Test
What was the result of the Heartworm Test?
Negative
Positive
Unsure
Has this cat had a Feline Leukemia (FeLV) test?
*
No
Yes
Unsure
Feline Leukemia Test Details:
Veterinarian or Clinic Name
Date of FeLV Test
What was the result of the Feline Leukemia Test?
Negative
Positive
Unsure
Has this cat had a Feline Immunodeficiency Virus (FIV) test?
*
No
Yes
Unsure
Feline Immunodeficiency Virus (FIV) Test Details:
Veterinarian or Clinic Name
Date of FIV Test
What was the result of the FIV Test?
Negative
Positive
Unsure
Has this pet been spayed or neutered?
*
No
Yes
Unsure
Has this cat been declawed?
*
No
Yes
Unsure
Does this pet have any current or previous special or medical issues?
Medications, special diet, allergies, previous injuries, etc.
Behavior and Personality:
Please provide honest and detailed information. These answers provide us with important information that will allow us to find appropriate homes and are not necessarily used to determine eligibility.
What is this dog's personality like in general?
*
Please include energy level, quirks, likes and dislikes, anxiety or fear issues, etc.
Which best describes this cat's personality?
*
Please check all that apply.
Social Butterfly
Independent Loner
Ultra Confident
Grumpy Pants
Scaredy Cat
Wild and Mean
Additional personality details:
Please include energy level, quirks, likes and dislikes, anxiety or fear issues, etc.
This dog does NOT do well with:
*
Cats
Any Dogs
Certain Dogs
Any Children ( < 12 y.o.)
Certain Children
Certain People
Livestock
Unsure
N/A. This dog gets along with everything.
This cat does NOT do well with:
*
All Cats
Certain Cats
All Dogs
Certain Dogs
Unsure
N/A. This cat gets along with everything.
Please provide additional details about the dog's behavior with cats:
Please provide additional details about the dog's behavior with other dogs:
Please provide additional details about the types of dogs your dog does not do well with and their behavior toward them:
Please provide additional details about the dog's behavior around children:
Please provide additional details about the types of children this dog does not do well with and the behavior toward them:
Please provide additional details about the types of people this dog does not do well with and the behavior towards them:
Please provide additional details about the types of livestock this dog does not do well with and the behavior towards them:
Please provide additional details about the cat's behavior with cats:
Please provide additional details about the types of cats this cat does not do well with and the behavior towards them:
Please provide additional details about the cat's behavior around dogs:
Please provide additional details about the types of dogs this cat does not do well with and the behavior towards them:
Perks:
This is just for extra information and bears no weight in the intake process. Please check all that apply:
Potty Trained
Knows Commands
Gentle on Leash
Crate Trained
Other
Which commands?
Other Perks:
PAWS SHELTER OF CENTRAL TEXAS is a non-profit, No Kill shelter and runs entirely on donations to care for its animals. A $55
minimum
donation is required for owner surrenders.
By submitting this form
, I am stating that all above information contained in this form is complete and true and understand that I have begun the process of relinquishing ownership of this/these animals to PAWS Shelter of Central Texas. I also understand that PAWS Shelter of Central Texas requires a behavior evaluation for each pet before completing the surrender process and by no means guarantees that this/these animals will be accepted into their adoption program upon completion.
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