Surrender Application

Basic Information - Step 1 of 2

Owner Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Animals Name/Nickname:

Type of animal: *

Animals Age:

Sex:

Animal Breed(s):

Is this Animal Spayed/neutered? *

Does this animal have a microchip?

Microchip Number:

Why are you surrendering this animal? *

Where did you originally acquire this animal?

How long have you owned this animal?

What type of enclosure is this pet currently living in? (Please Explain) *

Is this pet currently living indoors or outdoors?

Is this animal hand tame? *

Please Explain:

What other animals does this animal currently live with or comfortable with? *

What type of food is this animal currently eating? *

Does this animal have (or has had in the past) any known medical issues? *

Please explain: *

Is this animal currently on any medications? *

Please explain: *

Does this animal have any known behavior issues? *

Please explain: *

Is there anything else you would like us to know about the animal?

Are there any pictures that you can provide us of the animal?

Click or drag files to this area to upload. You can upload up to 5 files.

Would you like to receive pictures/updates on this animal?

I agree that all information submitted on this application is true and accurate. I understand that if I adopt an animal from One Love, this form will become part of the adoption record. By submitting this application I consent to receiving emails from One Love Animal Rescue and am aware that I can unsubscribe to these emails at any time. *

Today's Date: *

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"Saving the life of one animal may not change the world, but for that one animal, the world will change forever"