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2. PLEASE READ

   Complete this form if you are interested in surrendering your pet to Haywood County Animal Services. Please be advised, we are currently operating under a managed intake system in which all owner surrenders are placed on a waiting list and contacted as space becomes available. There is a $40 owner surrender fee, payable by cash or check only, per animal surrendered. We strongly advise you continue to search for a home for your pet even after submitting the request form.

4. Name*
5. Email Address
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Reason for Surrender*
15. Proof of Ownership*
    -- Select One --PhotographsBill of SaleVeterinary RecordsAdoption ContractLicense/ID CardMicrochipNone

    Do you have current proof of ownership of this animal? (i.e, vaccine records, photos, etc.)

17. Animal Name*
18. Animal Breed*
20. Approximate Animal Age*
21. How long have you owned this animal?*
22. Estimated Animal Weight*
24. Animal Sex*
    -- Select One --Male - UnalteredFemale - UnalteredMale - NeuteredFemale - Spayed
25. Is the animal up to date on rabies vaccines?*
    -- Select One --YesNoUnsure
27. Where was the animal primarily kept?*
    -- Select One --IndoorsOutdoorsBoth
28. What is the animal's energy level?*
    -- Select One --LowModerateHigh
30. Has this animal ever bitten anyone that has resulted in broken skin?*
    -- Select One --YesNo
31. If yes, please explain the whole situation in detail (Please include if this bite resulted in a filed bite report):
33. Animal's Primary Veterinarian*
34. Primary Veterinarian Phone Number*
36. Does this animal display any of the following behavioral issues? (Check all that apply)*

    1. Aggression towards Dogs
    2. Aggression towards Cats
    3. Aggression towards Men
    4. Aggression towards Women
    5. Aggression towards Small Children (Infancy - 5 yrs old)

    1. Aggression towards Children (5 yrs - 13 yrs)
    2. Food Aggression/Resource Guarding
    3. Territorial Aggression
    4. Fearful Aggression
    5. Separation Anxiety

    1. Excessive Jumping/Nipping
    2. Lack of Basic Manners
    3. Excessive Barking
    4. None of these apply
38. What positive behaviors does the animal display? (Please check all that apply)*

    1. Good with Dogs
    2. Good with Cats
    3. Good with Kids

    1. Housebroken
    2. Leash Trained
    3. Basic Manners

    1. Litterbox Trained
    2. None of the above
40. What brand of food is the animal currently eating?*
42. If someone is interested in adopting this animal, may we contact you for additional information?*

    1. Yes

    1. No
44. Please enter any more information that you think may be relevant to this animal:
46. Photo Upload

    Upload a photo of pet

49. Terms of Surrender*

    1. ACKNOWLEDGEMENT OF SURRENDER: By surrendering an animal to Haywood County Animal Services, I acknowledge that I am voluntarily giving up all rights and ownership of the animal. 

    2. OWNER SURRENDER FEE: I understand and agree that I am responsible to pay a $40 owner surrender fee per animal at the time of surrender, payable by cash or check only. 

    3. ADOPTION RESTRICTION: I agree that by surrendering an animal, I will be unable to adopt from Haywood County Animal Services for the time period of one calendar year, starting on the date of surrender.

    4. ANIMAL HEALTH AND HISTORY: I confirm that I have provided accurate and complete information about the animal's health history, behavior, and any known issues that may affect its adoptability.

    5. ACKNOWLEDGMENT: I hereby affirm that all the information provided in this submission is accurate, truthful, and up to date to the best of my knowledge. I acknowledge that any inaccuracies or omissions in the information may affect the processing of my submission. Furthermore, I understand that any intentionally false information could lead to potential consequences, including but not limited to denial of surrender. I am committed to maintaining the integrity of this submission and will promptly notify the relevant parties of any changes or updates to the details provided herein.

    1. I agree
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field