Please double check the spelling of your email address (firstname.lastname@example.org). Please check your spam folders if you do not receive a message from us within a few minutes.
Best phone number to contact you: *
We never make unsolicited calls or sell your phone number!
Someone other than you that we can contact in case of emergency.
If not a home phone, another phone we could use to get a hold of you.
* What type of animal surrender would you like to do? *
If surrendering your own pet, we require the following intake/surrender fee:
This can be paid via cash, credit/debit card or check.
If this is a found animal, please tell us the circumstances.
Please give as much details as possible (street name, nearby business or park, etc) As an example: "I found this dog sleeping under my porch" or "This kitten was stuck in a garbage can behind the Kahaluu Elementary School" Remember, providing more details may help us find the owner.
If this is a personal pet, please explain why you're surrendering it to us. *
Please be as specific as possible. is it health concerns for the animal, behavioral concerns, any and all reasons for your giving up your pet. This will help us to take care of the animal and to find the right match. Ignore this question if it's not your pet.
What type of animal are you surrendering? Do you know the animal's name? * Pet Image Max. file size: 64 MB. What is the sex of the animal? * How old is this animal? *
Please put the birth-date if you have it otherwise estimate as close as you can or leave blank. (example: 3 months & 2 weeks)
Is this animal spayed or neutered? * If the animal is spayed or neutered, do you know when and where?
Clinic or doctor's name, city, state, phone number. Any information will be helpful.
Is this animal part of a litter being turned in?
If yes, do you know how many in the litter?
What is the breed of this animal? If it's a mixed breed, do you know what the primary and secondary breeds are?
(example: "Terrier and Poodle" or "Siamese and Persian"
Please describe the animal's tail.
Is it Long, Short, Bushy, Curly, Docked, Deformed, etc? If the animal is missing it's tail or if it's tail is damaged, do you know how it happened? For example, born without a tail, removed at vets, accident, etc
Please describe the animal's ears.
Are the ears curled, erect, floppy, cropped, deformed, etc? If the animal's missing one or more ears or if they are damaged, do you know how it happened?
Please describe any distinguishing Marks
Scars, stripes, bald patches, etc.
Length, color(s) and type of fur
Please include primary and secondary colors if more than one. Example: "Long thin black and white fur" or "short thick orange fur"
Does this animal have any of the following? If the animal has a chip, ID number or tattoo, please describe.
If you know where the animal was chipped or if you know the ID number or can describe the tattoo, please do so.
Do you have any other information you would like to share with us about this animal? You must agree with the following 11 items in order to surrender an animal. * *
Please read each item carefully and only check mark if you understand it and agree to it. Keep in mind that even if you just found the animal, if it's in your possession that makes you the "temporary guardian".
* * * * * * * * * * Submission of this form does not guarantee we will be able to accept your dog/cat. We will contact you to discuss if and when there is space available to further evaluate your application and pet.
Please note the following before you ”sign” this legally binding agreement:
Almost every civilized country in the world has adopted an electronic signature law. The Electronic Signatures in Global and National Commerce Act (ESIGN) and the Uniform Electronic Transactions Act (UETA) have established that electronic records and signatures carry the same weight and legal effect as traditional paper documents and handwritten signatures. A document or signature cannot be denied legal effect or enforceability solely because it is in electronic form.
According to U.S. Federal law, an electronic signature is an ”electronic sound, symbol, or process, attached to or logically associated with a contract or other record and executed or adopted by a person with the intent to sign the record.”
In other words, typing your name on this legally binding document is the same as signing it with a pen. OWNER / GUARDIAN SIGNATURE: *
By electronically signing this volunteer form I attest that everything I have stated within this document is true to the best of my knowledge.
Remember, questions with an asterix * are mandatory, if you missed any, those questions will be highlighted with red. They must be filled out before you can submit the document.
Please take a moment to review your entries for accuracy.
Once you click submit, your form will be saved and a copy will be sent to the email address you entered above. Please double check that the email you entered is (email@example.com). If you do not receive a response from us within a few minutes, please check your spam folders. If you have not received a response from us in a timely manner, please contact us via email or telephone.