GCHS in the Media

PET INTAKE FORM

Send medical records to ownersurrender@gulfcoasthumanesociety.org

Owner Name(Required)

Phone(Required)

Email(Required)

Address

City

State

Zip

Personnel Intake Name(Required)

Pet’s Name(Required)

Breed(Required)

Color(Required)

Sex(Required)

Fixed(Required)

Microchip(Required)

File

Max. file size: 50 MB.

Vet Name:(Required)

Vet Phone Number:(Required)

Why are you surrendering your pet?(Required)

Where did you acquire your pet?(Required)

How long have you had your pet?(Required)

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.

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)

If yes, explain

Please tell us about your pet and any special characteristic personality traits, or special needs:(Required)

STATEMENT OF SURRENDER

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)

I would like to make a donation in the amount of $ to the Gulf Coast Humane Society to assist in the care of the animals in need.

Signature

Phone

This field is for validation purposes and should be left unchanged.

Gulf Coast Humane Society

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Adopt

Way To Give

Volunteer / Events

Our Clinics

Pet Resources

About Us

Owner Surrender Form

PET INTAKE FORM

Send medical records to ownersurrender@gulfcoasthumanesociety.org

STATEMENT OF SURRENDER