CMAR ~ Animal Surrender Request Form

CMAR ~ Animal Surrender Request Form
PLEASE READ ENTIRE PARAGRAPH!!!

Filling this form out does not guarantee that the animal(s) you wish to surrender will be automatically accepted by CMAR. We have the right to refuse any animal, and acceptance is based on space/funding available.

We do not require a surrender fee, but do ask that if you are able to make a donation for the animal(s) care, that you please do so. It costs us a minimum of $100 per animal in vet care alone, and we are ran completely off of donations.

I AGREE TO SURRENDER THE ANIMAL(S) LISTED BELOW TO CHASING MIRACLES ANIMAL RESCUE. I WILL KEEP POSSESSION OF SAID ANIMAL UNTIL CMAR CAN OBTAIN IT INTO THEIR POSSESSION. UPON SIGNING THIS FORM I UNDERSTAND THAT THE ANIMAL NOW BELONGS TO CMAR, IF THEY CHOOSE TO ACCEPT THE ANIMAL(S), AND I CANNOT RELINQUISH IT TO ANOTHER PARTY WITHOUT THEIR PERMISSION. IF I GIVE SAID ANIMAL AWAY I MUST REIMBURSE THEM FOR ANY AND ALL VETTING OR FOOD/SUPPLIES THAT THEY'VE PROVIDED.

VACCINATION COST - $10 EACH

DEWORMER - $10 EACH

FLEA/TICK PREVENTION - $10 EACH

SPAY OR NEUTER- $100 EACH

HEARTWORM OR OTHER TESTING- $25 EACH

HEARTWORM PREVENTION- $10 EACH

I UNDERSTAND THAT THEY ARE A FOSTER BASED RESCUE AND IT MAY TAKE THEM SOME TIME TO FIND PLACEMENT FOR SAID ANIMAL.
IF YOU ARE WANTING TO SURRENDER PUPPIES OR KITTENS WE REQUIRE THAT THE MOTHER TO THEM BE SPAYED PRIOR TO US TAKING POSSESSION OF THEM, OR SURRENDERED WITH THEM. WE WILL NOT TAKE THEM WITHOUT ONE OR THE OTHER. IF THEY ARE STILL NURSING, AND THE MOTHER CANNOT BE SPAYED YET, SHE MUST EITHER BE SURRENDERED AS WELL, OR YOU MUST FOSTER UNTIL THE BABIES ARE WEANED AND SHE CAN BE SPAYED. YOU WILL BE RESPONSIBLE FOR THE COST OF THE SURGERY.

BY FILLING THIS OUT, AND SIGNING BELOW YOU AGREE TO THESE TERMS.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Please leave a valid email address that will be monitored for further correspondence about your surrender request. If you have Facebook you can also reach out there advising us that you've completed an owner surrender request.
Email*

Confirmation Emailexample@example.com
Type/Breed of animal your wanting to surrender:*
Number of animals you are wanting to surrender. *
Please list the name of every animal you are wanting to surrender. *
Age of animal:*
Please list the age(s) of every animal you are wanting to surrender.
Animal's gender:*

MaleFemaleIf more than 1 animal please list additional genders below.
Additional genders
Is the animal spayed or neutered?*

YesNoNot old enoughNot a breed you spay or neuter
Please list if any additional animal's you are surrendering are spayed or neutered.
If the animal(s) are spayed/neutered, please list the date of surgery and the name/number of the vet clinic who performed the surgery.
Is the animal up to date on vaccinations?*

YesNo
If yes please list the date last vaccinations were given.
Whom gave the vaccinations?
If a veterinarian gave the vaccinations please list their clinic name and phone number.
Has the animal(s) ever been tested for heartworms?*

YesNo
If yes, date of last heartworm test.
Is the animal current on heartworm prevention?*

YesNo
Please list the date given and brand of heartworm prevention.
Is the animal current on flea and tick prevention?*

YesNo
If yes what kind, and when was it last given?
Has the animal received any vet care that you know of?*
How long have you owned, or been in possession of said animal?*
If the animal was found or a stray, what date did you take custody of said animal(s)?*
If the animal was a stray where was the animal found? Please include street name and town name.*
If the animal was a stray has it been taken in and scanned for a microchip?*

YesNoOther
How many animals do you own? What breeds are they? What are their ages? What are their genders?*
Is the animal good with other dogs? We will require proof via a dog test for other dogs at the time of surrender, and if not dog friendly your dog will be refused.*

YesNoOther
Is the animal(s) good with cats? Most of our foster homes have cats so if your animal has a known history of attacking or killing cats please advise us for safety.*

YesNoOther
Explanation of above, if needed.
Is the animal good with children?*

YesNoI don't know
Is the animal housebroken?*

YesNoNot Applicable
Does the animal have any apparent health issues?*

YesNo
If yes to the question above please list them here, if no please type NA:*
What is your reason for wanting to surrender the animal(s)?*
Do you have issues with keeping said animal(s) inside of a fence? If yes please explain how they escape in the following box.*

YesNo
They escape by:
How tall is your fence, and what type of material is it made out of? Type n/a if no fence.*
Does the animal have any bad habits? Ex: Chewing, digging, biting, destructive, etc?*
Has the animal ever bitten a person?*

YesNo
If yes explain:
Are you willing to foster the animal until we can find placement? *

YesNo
Are you willing to monetarily sponsor the animal's vet care, or take the animal to a vet of your choice and pay for the vet care needed?*

YesNoCould partially help with the expense.Other
Please attach at least 2 clear good pictures of the animal(s) you wish to surrender. *

Browse Files

Cancelof
Browse Files

Cancelof
Browse Files

Cancelof
I understand that CMAR has the right to refuse accepting any animal. I understand, and agree that if they choose to accept my animal(s) into their rescue I waive all legal rights to said animal, and it now belongs to and is the property of Chasing Miracles Animal Rescue. If my animal has any vet records, including vaccination records they will need to be brought to CMAR with said animal. The animal(s) will not be accepted without copies of vet records, if there are any. I agree to relenquish all rights of my animal(s) to CMAR, and waive my right to any information about them after surrendering them. All information pertaining to such will be strictly up to the members of CMAR. By signing below I realize that this is considered a legal and binding agreement between myself and Chasing Miracles Animal Rescue.
Signature*

Clear
Date*

MonthDayYear
Time*

:HourMinutesAM/PM Option
Should be Empty:

CMAR ~ Animal Surrender Request Form

Please leave a valid email address that will be monitored for further correspondence about your surrender request. If you have Facebook you can also reach out there advising us that you've completed an owner surrender request.