Gulf Coast Humane Society
Home
Adopt
Adopt
Adoptable Dogs
Adoptable Cats
Dolly’s Dream
Owner Surrender
(239) 332 0364
Stay Connected
Ways To Give
Way To Give
Supplies Wish List
Pet Food 4 Furever Families
Second Chance Fund
Why to Give
Spay It Forward
Okan’s Fund
(239) 332 0364
Stay Connected
Volunteer / Events
Volunteer / Events
Volunteer Opportunities
Senior to Senior Program
Community Service
Foster
Trap-Neuter-Return
Events
(239) 332 0364
Stay Connected
Services / Clinics
Our Clinics
Veterinary Clinic
Spay & Neuter Clinic
Online Pharmacy
Pet Resources
Dog Obedience Workshops
Pet-Friendly Rental Locator
Planning
Stop Dog Fighting
(239) 332 0364
Stay Connected
About
About Us
Meet The Team
Media
Faq
Contact us
Board of Directors
Rescue Partnerships
Support Our Partners
Job Opportunities
(239) 332 0364
Stay Connected
Contact
Donate Now
Home
Adopt
Adopt
Adoptable Dogs
Adoptable Cats
Dolly’s Dream
Owner Surrender
(239) 332 0364
Stay Connected
Ways To Give
Way To Give
Supplies Wish List
Pet Food 4 Furever Families
Second Chance Fund
Why to Give
Spay It Forward
Okan’s Fund
(239) 332 0364
Stay Connected
Volunteer / Events
Volunteer / Events
Volunteer Opportunities
Senior to Senior Program
Community Service
Foster
Trap-Neuter-Return
Events
(239) 332 0364
Stay Connected
Services / Clinics
Our Clinics
Veterinary Clinic
Spay & Neuter Clinic
Online Pharmacy
Pet Resources
Dog Obedience Workshops
Pet-Friendly Rental Locator
Planning
Stop Dog Fighting
(239) 332 0364
Stay Connected
About
About Us
Meet The Team
Media
Faq
Contact us
Board of Directors
Rescue Partnerships
Support Our Partners
Job Opportunities
(239) 332 0364
Stay Connected
Contact
Donate Now
Rescue Partnerships
Southwest Florida German Shepard Rescue
Heart Bandits American Eskimo Dog Rescue
Collier County Domestic Animal Services
Big Cypress German Shephard Rescue
Bailey’s way rescue, inc.
Barking Matters Rescue
Big Hearts for Big Dogs Rescue
Clewiston Animal Services
Caloosa Humane Society
One More Day Foundation
Haven on Earth Animal League
Boxer Rescue Angels of Florida
Golden Retriever Rescue of Southwest Florida
Lee County Domestic Animal Services
Canine Castaways
Gulf Coast Doxies
Mastiff Rescue of Florida
Humane Society Naples
Labrador Retriever Rescue of Florida
Paws of Lee County
Parker’s Rainbow Bridge Animal Rescue
Love is Forever Rescue
The Pit Bull Crew
Pug Rescue of Florida
My Pit Bull is Family
Senior Paws Sanctuary
Team Moose Animal Rescue
Helping Paws Animal Sanctuary
Nykol’s Rescues
Fur and Tails Rescue
Owner Surrender Form
PET INTAKE FORM
Send medical records to ownersurrender@gulfcoasthumanesociety.org
First Name
(Required)
Last Name
(Required)
Phone
(Required)
Email
(Required)
Address
(Required)
City
(Required)
State
(Required)
Zip
(Required)
Date
(Required)
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Pet’s Name
(Required)
Pet Type
(Required)
Dog
Cat
Pocket Pe
Breed
(Required)
Color
(Required)
Age / D.O.B
(Required)
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
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)
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
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
Date
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Email
This field is for validation purposes and should be left unchanged.
×
Gulf Coast Humane Society
Gulf Coast Humane Society
