Gulf Coast Humane Society
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Home
About
About Us
Blog
Board of Directors
Contact us
FAQs
Financials
Job Opportunities
Media
Meet The Team
Rescue Partners
(239) 332 0364
Stay Connected
Adopt
Adopt
Adoptable Cats
Adoptable Dogs
Dolly’s Dream
(239) 332 0364
Stay Connected
Capital Campaign
Events
Give
Way To Give
Legacy Planning
Lifetime Pack Leader Club
Okan’s Fund
Pack Leader Club
Pet Food Pantry
Recurring Donation Program
Second Chance Fund
Spay It Forward
Supplies Wish List
(239) 332 0364
Stay Connected
Medical Clinics
Our Clinics
Spay & Neuter Clinic
Veterinary Wellness Clinic
Online Pharmacy
(239) 332 0364
Stay Connected
Resources
Pet Resources
Dog Obedience Workshops
Pet Food Pantry
Pet Legacy Program
Stop Dog Fighting SWFL
Surrendering Your Pet
(239) 332 0364
Stay Connected
Volunteer
Volunteer / Events
Volunteer Application and Opportunities
Foster Program
Community Service
Senior to Senior Program
Trap-Neuter-Return
What Our Volunteers Say
(239) 332 0364
Stay Connected
Donate Now
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Cat Adoption Special
CLOSE
Owner Surrender Form
PET INTAKE FORM
First Name
(Required)
Last Name
(Required)
Phone
(Required)
Email
(Required)
Address
(Required)
City
(Required)
State
(Required)
Zip
(Required)
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(Required)
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Pet’s Name
(Required)
Pet Type
(Required)
Dog
Cat
Pocket Pe
Breed
(Required)
Approximate Weight:
(Required)
Color
(Required)
Age / D.O.B
(Required)
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Sex
(Required)
Fixed
(Required)
Microchip
(Required)
Up to date on vaccines?
(Required)
Yes
No
(Attach vaccine records)
File
Max. file size: 50 MB.
Vet Name:
Vet Phone Number:
Why are you surrendering your pet?
(Required)
Where did you acquire your pet?
(Required)
How long have you had your pet?
(Required)
Is your animal current on Heart-worm/Flea Prevention? If so, list below and attach medical records
(Required)
Yes
No
Other
When last given
File
Max. file size: 50 MB.
Does your pet have any current or past health conditions or injuries? If so-list below and attach medical records
(Required)
File
Max. file size: 50 MB.
Who does your pet get along with?
(Required)
MEN
WOMEN
CHILDREN (1-3 years)
CHILDREN (4-7 years)
CHILDREN (8-11 + years)
DOGS
CATS
Select All
Has your pet ever shown signs of aggression?
(Required)
Yes
No
If yes, was it provoked? Please explain
Does your pet live Indoors, Outdoors or both
(Required)
What type of food does your pet eat?
(Required)
Any destructive habits?
(Required)
Yes
No
If yes, explain
Is your pet house broken / Litter trained?
(Required)
Yes
No
Obedience training?
(Required)
Yes
No
Please tell us about your pet and any special characteristic personality traits, or special needs:
(Required)
STATEMENT OF SURRENDER
I certify that I
(Required)
Do own the animal described above
Do NOT own the animal described above
I hereby surrender all interest to the Gulf Coast Humane Society. My interest in this animal has now been voided and I will not be given any information on the welfare or disposition of this animal.
(Required)
Please type initials above
There is no minimum set time for holding this animal. The holding time depends on the animal’s health, behavior and adoptability. It is also agreed that neither said society nor its management and employees shall incur any obligation to me on the disposition of the above listed animal. I certify that this animal has not bitten another animal or human within the last 10 days. I have read and understand that I have surrendered my rights and interest towards this animal.
Signature
(Required)
Date
(Required)
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The cost to care for and re-home pets can be in the hundreds of dollars for each animal that comes into our care. GCHS is a private, non-profit organization that does not receive government funding. We are also not affiliated with any national humane organizations. GCHS asks for a surrender fee to help subsidize this cost. The fee is non-refundable and will be collected only if we are able to accept your animal after its evaluation and required testing. Dogs - $100.00 if not spayed/neutered Dogs - $75.00 if spayed/neutered Cats - $50.00
Signature
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Comments
This field is for validation purposes and should be left unchanged.
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Gulf Coast Humane Society
Gulf Coast Humane Society
