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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 $10 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*
14. Reason for Surrender*
15. Proof of Ownership*
    -- Select One --PhotographsBill of SaleVeterinary RecordsAdoption ContractLicense/ID CardMicrochipNone
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. How was the animal obtained?*
    -- Select One --Rescue/ShelterPet StoreBreederOther
27. Is the animal up to date on rabies?*
    -- Select One --YesNoN/A

    Ferrets Only

28. Has the animal ever bitten anyone that has resulted in broken skin?*
    -- Select One --YesNoUnsure
30. If yes, please describe the incident:
32. Primary Veterinarian Name*
33. Primary Veterinarian Phone Number*
35. What brand of food is the animal eating?*
36. Amount of food and frequency?*
38. Is the animal receiving supplemental food? *

    Check all that apply.

    1. Leafy Greens
    2. Timothy Hay
    3. Pellets
    4. Fruits
    5. Vegetables
    6. Insects
    7. Other
    8. N/A
40. Where is the animal primarily kept?*
    -- Select One --IndoorsOutdoorsBoth
41. Primary Enclosure*
    -- Select One --Cage/TerrariumFree Roam
43. Has the animal been housed with the opposite sex?*
    -- Select One --YesNo
44. What is the animal's energy level?*
    -- Select One --LowModerateHigh
46. What positive behaviors does the animal display?*

    Check all that apply

    1. Good with dogs
    2. Good with cats
    3. Good with kids
    4. Good with same species
    5. Litter Box Trained
    6. None
    7. Unsure
48. Does the animal have any behavioral issues we should be aware of?*

    Check all that apply

    1. Animal Aggression
    2. People Aggression
    3. Aggression towards men
    4. Aggression towards women
    5. Aggression towards children
    6. Territory Aggression
    7. Food Aggression
    8. Resource Guarding
    9. Fear Aggression
    10. None of these apply
50. If someone is interested in adopting this animal, may we contact you for additional information?*
    -- Select One --YesNo
52. Please include any additional information relevant to this animal:
54. Photo Upload

    Upload a photo of animal

Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field