Surrender Form

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email

Type of Animal

Cat
Dog
Other

Sex of Animal

Does This animal belong to you?

Yes
No

Does this pet have a name? If so, what is it?

How long has this pet been in your care?

How did you come to have this pet in your custody?

Was this animal stray or abandoned?

Yes
No

If this pet was found as a stray or abandoned, did you take it to a local vet to have it scanned for a microchip free of charge?

Did you post a picture to For the Love of Louie Facebook page?

Did you file a found animal report with Genesee County Animal Control (or the county you live in)? 4351 W Pasadena Ave, Flint Township, MI 48504 (810) 732-1660?

Did you file a found animal report with Humane Society of Genesee County (or the county you live in)? G-3325 S Dort Hwy, Burton, MI 48519 (810) 744-0511 ?

How old is the animal? (please estimate if unknown)

How much does the animal weigh? (please estimate if unknown)

Does the animal have any known health problems? If so please list

What breed is the animal?

Does the animal have short/medium/long hair?

What circumstance/behavior has led you to surrendering the animal? We at Kreacher Konnections understand that this can be a very emotional and traumatic decision and you only need to go into as much detail as is important for the animals future placement.

Is the animal crate trained or house trained?

Does the animal get along with cats?

None
Some
Most
All
Has Never Met
Unknown
Only Males
Only Females

Does the animal get along with dogs?

None
Some
Most
All
Has Never Met
Unknown

Does the animal get along with kids?

None
Some
Most
All
Has Never Met

Does the animal get along with women?

None
Some
Most
All
Has Never Met

Does the animal get along with men?

None
Some
Most
All
Has Never Met

The animal seems to be generally:

passive
assertive
dominant

With food and/or toys the animal is:

passive
assertive
aggressive
protective

Is this animal currently pregnant?

Yes
No
Unknown

Is the animal spayed or neutered?

Yes
No
Unknown

Is the cat declawed?

Yes - front only
Yes - front and back
No
Unknown

Has the animal received any heartworm preventative?

Yes
No
Unknown

Has the animal been tested for heartworm (dogs) or FIV/FelV (cats)?

Yes - Positive
Yes - Negative
No
Unknown

Has the animal had any vaccinations? If so, please list.

Until what date can you hold the animal if Kreacher Konnections does not have an immediate foster home available?

Are you willing/able to act as the foster home for the animal while Kreacher Konnections tries to locate a forever home?

Yes
No
I need more information

I understand that the animals I foster are under my care and I am responsible for providing them with proper food, shelter and water. I agree to give Kreacher Konnections at least a 14 day notice to make arrangements for the animals in my care. I agree that in no way am I to dispose, drop-off or “get rid” of any of the foster animals in my care except to screened and approved adopters.*

I Agree

I fully understand that as a volunteer or foster home provider for Kreacher Konnections there are certain risks and exposure to personal injury and/or damages to my real or personal property that may occur. It is my desire and intent in signing this application to indemnify and hold harmless Kreacher Konnections from any claim, cause of action or demand for any loses that may occur to me as a result of such activities in my capacity as a volunteer or foster home provider.*

I agree

Is there anything else Kreacher Konnections should know about this animal?

Are you donating any monetary funds to help with the care of this animal? (Cats vaccinations and sterilizations cost approximately $75 Dogs cost approximately $125) If so, please visit www.kreacherkonnections .org

Yes
Not at this time

Please upload 2 pictures of the animal (one of the face & one of the body)

Drop files here or

Include pictures or scans of proof of medical care if possible.

Drop files here or

Being the legal owner of the above stated animal, I hearby relinquish ownership and all rights to this animal to Kreacher Konnections. I cannot reclaim this animal once it is in the possession of Kreacher Konnections. I may apply to the organization for the adoption of the animal and understand that the final decision for the return of the animal rests only with the board members of Kreacher Konnections. Kreacher Konnections shall attempt to find this animal a suitable home, but neither the organization, nor the members there of shall be held responsible for the actions of the foster home, adoptive family and/or the animal. Any animal who is found to be suffering from an incurable disease or who demonstrates snapping, biting or aggression could be euthanized. I have read and understand the conditions outlined above, I agree and consent by my legal signature below.*

I agree

Your full name (This will serve as a digital signature)*

Date