Owner Surrender Request Form
Please complete as much information as possible. We strive to provide all pets coming into our program the best possible hope of success in placement with a permanent home. Providing as much information as possible allows us to do this for your pet.
There is a $60 animal surrender fee per pet (or $100 fee for heartworm positive pets) due at the time of surrender if your pet is accepted by the Humane Society of Morgan County.
Information provided will not affect whether or not we are able to take your dog into our program.
This form does not guarantee that we will accept your animal into our program. We may already have a waiting list at this time, and we must have an empty space before we can accept new animals. Please allow up to one business day for our employees to contact you after completing this online form.
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What is the urgency of surrender?
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What is your reason for surrendering this pet? Please be very specific. *
Pet's Name *
Species *
Pet's Breed *
Current Weight *
Date of Birth
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Age Now *
Is your pet spayed or neutered? *
Gender *
Is your pet microchipped? If yes, what is the number? *
How long have you had this pet? *
Where did you acquire this pet? *
Who is your current veterinarian?
Vet's phone:
Please provide us with dates of last received vaccines:  Rabies
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Please provide us with dates of last received vaccines:  DHPP/FVRCP
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Please provide us with dates of last received vaccines:  Bordetella
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Please provide us with dates of last received vaccines:  Heartworm Test
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Is your pet currently receiving Heartworm & Flea Preventative? *
If so, what is the manufacturer? (ie: Heartguard, Trifexis, Frontline, etc.)
Date of Last Prevention Received:
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Please list any medical issues diagnosed by a vet: (ie: diabetes, Cushings, food allergies, thyroid, etc.)
Please provide copies of all vet records. If your pet is current on vaccines this prevents over vaccination.
You can email copies of vet records to info@humanemorgan.org
Has the pet ever scratched or bitten a person? *
If yes, who was bitten:
Date of bite:
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If yes, did a bite break the skin?
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Was animal control involved?
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Please explain the circumstances of the bite.
Has the pet ever:
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What brand of food is your dog/cat currently eating?
Does your pet have any formal training? *
Is your pet leash trained? *
Is your pet house/litter box trained? *
Is your pet declawed? *
Does your pet chase livestock, cats, or other? *
Check all of the following that describes the pet: *
Required
Is the pet an: *
Required
Has the pet lived with children? *
If so, what ages?
Would you recommend your pet live with children in the future?
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Has the pet lived with cats? *
Would you recommend your pet live with other cats in the future?
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Has the pet lived with dogs? *
If yes, describe the other dogs (breed, size, etc.)
Would you recommend your pet live with dogs in the future?
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Has the pet lived with other animals (such as farm animals)? *
What are the pet's favorite activities or objects? *
What does the pet dislike or fear? *
Where is the pet kept during the day? *
Where does the pet sleep at night? *
Does your pet travel well in a car? *
Is there anything else a future owner should know about this pet? *
Owner's Information
Owner's name: *
DL# *
Address: *
City: *
State: *
Zip: *
Phone: *
Email: *
Signature Page
My signature certifies that I am the owner of, or have the authority to surrender to the Humane Society of Morgan County the animal described above. I hereby relinquish all rights of ownership and any right to information on the disposition of said animal. I also authorize the release of any veterinary records regarding the animal. I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behavior, history, and anything else that may affect the safe placement of the animal in a new home, and that all statements made above are true and correct to the best of my knowledge.

The Humane Society of Morgan County shall have sole and exclusive legal right to make all outcome decisions and take all actions deemed appropriate, including return to owner, adoption, or euthanasia. At no time in the future will we communicate the outcome of the animal to you or any other party.
Owner's Signature: Type your name as your signature. *
Date: *
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