Surrender Form

Please fill out this important form if you wish to surrender your animal to Animatch.

Date / MM / DD YYYY
Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Email address
Home Phone # * - ### - ### ####
Cell Phone or Work Phone # - ### - ### ####
Animal Information
Name of Animal *
Sex of Animal *
Male Female
Animal's Date of Birth (if unknown, approximate age)
*
Weight of dog
Description/Breed/Mix *

Enter the animal description, breed or mix.
How long have you had this animal? *
Where did you get this animal from? *
Family/Friend Breeder Found Classified/Newspaper Berger Blanc SPCA Montreal SPCA Laval Pet Store Other
Reason for surrender *
Name of Veterinarian
Veterinarian phone # - ### - ### ####
Veterinarian address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Animal Medical History

Is this animal...
If so, can you provide us with the vaccination certificate? *
Yes No
Sterilized? *
Yes No
Dewormed? *
Yes No
Does your pet have any allergies? *
Yes No Don't know
Animal's Environment

Is this animal...
An outside dog? *
Lives outside Lives inside
House trained? *
Yes No
Cage trained? *
Yes No
Paper trained? *
Yes No
Leash trained? *
Yes No
Does your pet suffer from or show signs of separation anxiety? *
Yes No
If so, please describe your dog's symptoms.
If so, please describe your dog's symptoms.
Animal History

Does this animal...
Bark? *
Yes No
Bite? *
Yes No
Chew *
Yes No
Dig? *
Yes No
Escape or run away? *
Yes No
Jump on furniture? *
Yes No
Jump over or crawl under fences *
Yes No
Good Behavior

Does this dog...
Behave in the car?
Yes No
Behave with children? *
Yes No
Behave with other dogs? *
Yes No
Behave with cats? *
Yes No
Behave with people in general? *
Yes No
Was this your first dog? *
Yes No
Food
Food Brand *
Type of food *
Canned Dry
Has this dog received any kind of training? *
Yes No
If so, what kind?
Obedience Agility Rescue Attack Other
Household Story
Is your dog left alone? *
Yes No
If so, for how long?
Where is the best place to keep your dog when he/she is left alone? *
Where does your dog sleep at night? *
Has this dog ever lived with other dogs? *
Yes No
If so, how does your dog behave around them?
Are there any children in the household?
Yes No
If so, what are their ages?
How does your dog behave around the children?
Is your dog rough? *
Yes No Sometimes
Is your dog mouthy? *
Yes No
Activities & hobbies
What is your dog's favorite game to play? *
Do you have a fenced yard? *
Yes No
How high is your fence? *
Does your dog fetch? *
Yes No
Does your dog go off leash? *
Yes No
Does your dog get walked? *
Yes No
If so, how many minutes a day? *
Does your dog play by himself/herself?
Yes No
Will your dog come when you call him? *
Yes No
Does your dog ever meet new dogs on his walks? *
Yes No
If so,what is your dog's reaction to them? *
Do you let your dog sniff/touch/play with these new dogs? *
Yes No
When your family is eating a meal, where is your dog? *
If you are in your living room watching tv, where is your dog? *
Your dog's habits
When guests /visitors/Purolator or service people come to the door, where is your dog kept? *
Outside Cage Room Free Held by collar or leash
How long does it take your dog to calm down when someone comes to the house? *
Has this animal ever nipped at you or someone in your family or entourage? *
Yes No
What is/has been your dog's response when you try to go near him/her while he/she is eating or chewing on a bone? *
Helpful information
What are your dog's best qualities? *
What are your dog's worst habits? *
How is your dog best disciplined? *
What kind of naughty things does your dog do that you've needed to discipline him/her for? *
If you could change one of your dog's bad habits, what would it be? *
What commands would be helpful to teach your dog before he goes to another home? *
Does your dog have any previous notable medical history? *
Yes No
If so, please provide details here or submit Vet report
If your dog is considered unadoptable by Animatch, are you willing to take him back? *
Yes No
If we do contact you for this reason, are you willing & able to take the animal back within 48 hours? *
Yes No
Has this animal been outside of Canada prior to this surrender? *
Yes No
If so, provide names of countries.
Is your dog tattooed / micro-chipped or otherwise identifiable? *
Yes No
If so, please provide details.
Is there anything else that you would like to declare about this animal at this time of surrender? *
Yes No
If so, please provide details
Are you the main companion to this animal? *
Yes No
To the best of your knowledge, is there anyone else that may lay a claim as guardian or companion to this animal? *
Yes No
If so, please provide details.
Please send us a photo of the dog that you wish to surrender to helen.animatch@gmail.com and write the dog's name in the subject line.
Photo sent?
Yes No
Terms & conditions *
I certify that this animal is in good health and has no severe behavioral problems. If the animal is proven non adoptable due to health or behavioral problems, these problems will be discussed between Animatch and our veterinarian and a decision will be made as how to proceed with the problem. Please note that euthanasia might be the only option, despite our no kill policy. I understand that any surrender fees received by Animatch will not be refunded. I give Animatch permission to contact our vet for any or additional information.
Type the letters you see in the image below.

Surrender Form

Surrender Form

Animal Information

Animal Medical History

Animal's Environment

Animal History

Good Behavior

Food

Household Story

Activities & hobbies

Your dog's habits

Helpful information