Owner Surrender Form - New Albany Animal Shelter

This form is reserved for New Albany, IN residents who are in need of placement for their pet and for pets previously adopted from our animal shelter. Owners must fill out this form completely and as detailed as possible. A copy of a current photo ID (such as a drivers license or state issued ID) must also be sent to nafcanimalshelter@yahoo.com. To help ensure proper cage space and movement towards adoptions, applications will be addressed as time and space permits. After receiving these items, a staff member will contact you to help offer solutions and aid, or to set up an appointment for surrender.

Owner Info

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Driver License # *

Used when creating your individual profile

Basic Pet Info

Pet's Name *

Pet Species *

Pet's Breed *

Pet's Colors and Patterns *

Pet's Age *

This pet is a *

Pet's Approx. Weight *

Pet Behavior and Medical History

I got this pet *

What rescue or adoption agency did the pet come from? *

I have had this pet for approximately *

What is the primary reason for needing to surrender this pet? *

Select any behavior issues this pet has *

Please elaborate on your pet's anxiety issues. Include any corrective measures that you have tried. *

Has this pet ever shown aggression? *

Please describe the situation when the pet was aggressive, and how often this is an issue.

Please check all that the pet has lived with

What animals has this animal lived with?

Did the pet have any issues with any animal or person in the home? Please elaborate.

This pet is used to being *

When this pet is alone, it is *

How much longer can you hold on to this pet to help ensure placement? *

Who is your pets veterinarian, and when was the last time he / she went? *

Please mark all that apply to this pet's medical history (must be able to verify) *

Please tell us about your pets underlying or chronic medical issues.

Please let us know more about your pet. The more we know how the pet is in a home, the better we can place it for adoption and find the perfect match.

With assistance in medical / training classes / food / etc, would you be able to possibly keep your pet? Please elaborate on what might help you. We want to help keep animals in their home if possible.