Surrender ApplicationPlease enable JavaScript in your browser to complete this form.Basic Information - Step 1 of 2Owner Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Animals Name/Nickname:Type of animal: *Choose AnswerCatDogBirdReptileSmall Mammal/OtherAnimals Age:Sex:Choose AnswerMaleFemaleUnknownAnimal Breed(s):Is this Animal Spayed/neutered? *Choose AnswerYesNoUnknownDoes this animal have a microchip?Choose AnswerYesNoUnknownMicrochip Number:Why are you surrendering this animal? *NextWhere 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?Choose AnswerIndoorOutdoorBothIs this animal hand tame? *Choose AnswerYesNoSlightlyOtherPlease 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? *Choose AnswerYesNoUnknownPlease explain: *Is this animal currently on any medications? *Choose AnswerYesNoUnknownPlease explain: *Does this animal have any known behavior issues? *Choose AnswerYesNoUnknownPlease 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?Choose AnswerYesNoI 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: *PreviousCommentSubmit
