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NHS Animal Surrender Form
Please fill this form out completely if you are inquiring about surrendering an animal to Nassau Humane Society.
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Date
*
MM
/
DD
/
YYYY
Address (Street, City, State, Zip)
*
Your answer
Phone Number
*
Your answer
Surrender Type
*
Owner Surrender
Stray
Number of Animals
*
Your answer
Animal Name(s)
*
Your answer
Breed(s)
*
Your answer
Age(s)
*
Your answer
Spayed or Neutered
*
Yes
No
Unknown
Vaccination Status
*
Up to date
Not vaccinated
Other:
Where does the animal primarily live
*
Indoors
Outdoors
Indoor/Outdoor
Is the animal on heartworm prevention?
*
Yes
No
Is the animal on flea/tick prevention?
*
Yes
No
House-trained or litter trained?
Yes
No
Other:
Clear selection
Good with:
*
Cats
Dogs
Kids
Other:
Reason for Surrendering:
*
Your answer
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