NHS Critter Surrender Form
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Your first and last name *
Your address (include city, state and zip code): *
Your county of residence *
Your phone number, including area code *
Your email address *
Please indicate the reason(s) for surrender: *
We may have alternatives to help keep your pet in your home OR provide you with information to find him/her a new home without having to enter the shelter. Would any of the following resources help you to keep your pet in the home? Check all that apply: *
Required
Critter's name: *
Where did you get your critter? *
How long have you had this critter? *
What breed is your critter (rabbit, guinea pig, bird, etc.)? *
What color is your critter? *
How old is your critter (specify in years, months, and/or weeks)? *
What is your critter's gender? *
Has your critter lived with other animals? *
If yes, please check all that apply *
Required
Please list specifics regarding the other pets your critter has lived with, or enter N/A (how many, type, age, gender, etc.): *
The critter lives in a: *
What is the approximate size of the enclosure? *
How often is the critter’s cage/habitat cleaned? *
What and how often have you been feeding this critter? *
List any supplements the critter is currently on and how often they are given, or enter N/A: *
Is this critter litter box trained? *
Is this critter used to being handled regularly? *
Has this critter ever bitten a person? *
When was the most recent bite (enter N/A if the answer above is no or unsure)? *
Did the most recent bite break skin? *
If yes, please describe the incident in detail. If no, enter N/A. (age of victim, body part bitten, severity of bite, what started the bite behavior, what was happening at the time of the bite) *
Has this critter ever been seen by a veterinarian? *
If yes, please list the veterinarian/clinic’s name and phone number. If no, enter N/A: *
Does this critter have any known health issues? *
If yes, please explain, or enter N/A: *
Is there a possibility the critter may be pregnant? *
Will you be bringing any of your pet’s housing/food supplies with it to the shelter? *
If yes, please list what you will be bringing, or enter N/A: *
Please tell us anything else about your critter that will help us find a perfect home for him/her. *
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