Name
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First Name
Last Name
Email
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Phone
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(###)
###
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Are you the legal owner of the pet that you're wanting to surrender?
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If you answered 'No,' please list the full name and phone number of the person who owns the animal.
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Is your animal a dog or cat?
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We only take dogs and cats.
If you selected dog, please state the breed.
If you selected cat, what is the breed?
If you have an exotic breed or purebred, please select 'other.'
What gender is your pet?
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What is your pet's age?
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How large is your pet?
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What color is your pet?
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What is your pet's name?
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How long have you had your pet?
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Is your pet up-to-date on all vaccinations (i.e. rabies, distemper, etc.)?
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What veterinary clinic do you take your pet to?
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Was this animal adopted from us at Noah's Ark Animal Sanctuary? If so, please list the year he/she was adopted and the name the animal is listed under as the adopter.
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If the animal was not adopted from us, where did you get your pet? Information to include: where your pet came from (i.e. breeder, rescue organization, store, friend/ family, social media, Craig's List, etc.), and city and state your pet came from.
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Why are choosing to surrender your pet?
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Please elaborate on why you need to surrender your pet. For example, if you're moving, why can't your pet move with you? Or if your pet has behavioral issues, please specify the issues.
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Does your pet demonstrate any signs of aggression? Please select all that apply.
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For dogs- if your dog has worked with any professional trainers, please list how long they were in training and/or how many classes they have completed.
For dogs- is your dog trained in any of these areas? Please select all that apply.
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For Cats- Do any of these apply to your cat? Please select all that apply.
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Has your pet ever bit a human and broke skin?
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If you answered yes to the previous question, please share the following- date of incident, who was bitten, how the bite happened, whether the bite was reported to your local animal control and whether your pet completed their 10-day bite quarantine.
How soon do you need to surrender your pet?
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Are you able to make a small donation towards your pet's care?
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