Surrender Form | Medfield Animal Shelter

How did this pet come into your care?*

I'm the owner

Surrendered to Animal Control

Found as a stray by Animal Control

Rescuer

Found as a stray by an individual

Other

Did you notify animal control you found this pet?*

Location pet was found*

Reason pet was surrendered to you*

Why did the owner surrender their pet to you?

Name*

First Last

Address*

Name of Organization

City*

State

Email*

Enter Email Confirm Email

Best phone # for reaching you?

Pet Information

What type of pet do you need to give up or transfer?*

What breed or breed mix is your dog?*

Name of Pet

Pet's age*

Sex*

Male

Female

Reason for surrender?*

How long has the pet been in your care?*

To the best of your knowledge has this animal bitten or shown potential to bite in the past?*

Has this pet lived with other animals*

Yes

I don't know

Please tell us about the other pets and how your pet gets along with them

Has this pet lived with children?*

Yes

There are children that visit frequently

I don't know

Is this pet housebroken?*

Yes

Working on it but still has accidents

If there are children, is this pet comfortable wiith them?

How many hours a day is this pet usually left alone?*

Is this pet up to date on vaccinations?*

Yes

Name and Contact Information of the vet that gave the vaccinations*

Does this pet have any health or behavioral issues?*

Does this pet allow handling and petting*

Has this pet bitten anyone in the last 10 days?*

Is this dog on heartworm preventative?*

Yes

Date last heartworm preventative given

When was this pet last seen by a vet?*

Is this pet spayed or neutered?*

Yes

Not sure

When do you need to surrender this pet?

The Medfield Animal Shelter is small and has limited capacity so there may be a waiting list.

What type of food does this pet eat and how much*

Tell us more about this pet and what type of home he/she would thrive in*

(I/we) fully understand that if the Medfield Animal Shelter agrees to take in the above-described pet that (I/we) hereby relinquish any and all legal, and equitable rights of ownership of the above-described pet. (I /we) represent that (I/we) are the lawful owner(s) of, and have good title to and the right and power to gift, sell, assign, transfer, convey and deliver said pet; and that said pet is free and clear from claims of ownership or other encumbrances of any kind or nature whatsoever by any other person or entity. (I/we) understand that The Medfield Animal Shelter will act in the best interest of said animal in its care and placement. By assuming ownership, The Medfield Animal Shelter reserves all rights in regard to making all decisions in regard to the pet's care, placement, and medical treatment. Furthermore, I agree that if the Medfield Animal Shelter finds this animal to have behavioral issues in the first 14 days after being relinquished, I/We will take it back.

Signature

You will be asked to sign this if/when we take in your pet.

Date pet relinquished

You will be asked to fill this in if/when we take in your pet.

Untitled

This field is for validation purposes and should be left unchanged.

Surrender Request

Pet Information