Owner Surrender Form

OWNER INFORMATION

Full Name:

Email:

Contact Number:

Address:

County:(Bibb County Residents only)

City:

State:

Zip:

OWNER SURRENDER

Today’s Date:

Animal’s Name:

Animal's Type

Breed:

Age:

Sex:

Spayed/Neutered?

Yes

No

Microchipped?

Yes, if yes, #

No

Upload Animal's Images

Why are you surrendering this animal? (Please provide as much information as you can.)

How long have you owned the animal?

How many homes has the animal had?

Was the animal adopted from a shelter or rescue?

Yes,

No

Where did you get the animals from?

Has the animal scratched or bitten a person the last ten (10) days?

Yes,

No

If yes, who was bitten:

Date of bite:

In what city?

Has the animal ever:

Bitten

Scratched

Lunged or attacked

None of these

If yes, did a bite break the skin:

Yes

No

Was Animal Services involved?

Yes

No

Please explain the circumstances:

The animal’s Veterinarian:

Phone:

City:

State:

Zip:

Is the animal current on vaccinations?

Yes

No

Is the animal current on Rabies Vaccination?

Yes, if yes, what is the Tag Number:

No

Please list any past or present injuries, treatments, or other medical history:

Check all of the following that describe the animal:

Has the dog lived with children?

Yes, if so, what ages:

No

Would you recommend your dog live with children in the future?

Yes

No

Has the animal lived with other animals?

Yes, if yes, what kind

No

Does the animal travel well?

Yes

No

What are the animal’s favorite activities and toys:

What does the animal dislike or fear:

Where is the animal kept during the day:

Where is the animal(s) kept during the night:

What type of food do you generally feed your animal?

Is there anything else a future owner should know about this animal:

My signature below certifies that I am the owner of/or have the authority to surrender to Bibb County Sheriff’s Office Animal Services, the animal described above. I hereby relinquish all rights of ownership and any right to information on the disposition of said animal. I also authorize the release of any veterinary records regarding the animal. I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behavior, history and anything else that may affect the safe placement of the animal in a new home, and that all statements made above are true and correct.

Signature:

Printed Name:

Bibb County Sheriff's Office

Animal Services

4214 Fulton Mill Rd., Macon, Ga. 31216 | (478) 621 - 6774

OWNER INFORMATION

OWNER SURRENDER

OWNER INFORMATION

OWNER SURRENDER

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