EmailMe Form - Pet Surrender Request

First & Last Name *

Phone *

Email *

Please ensure you have access and regularly check this email address, as we generally reach out by email first.

Address *

City, Zip Code *

Do you live within Fairfield County? (We are unable to accept surrenders from outside of Fairfield County) *

Yes

Number of pets to surrender *

Type of Pet(s) *

Dog

Cat

Other

Breed of Pet(s) (If Known) *

Age of Pet(s) *

Sex of Pet(s) *

Male

Female

Neutered Male

Spayed Female

For dogs, estimated weight: *

Reason for Surrendering *

Do they ever become toy or food aggressive? *

Have they ever bitten or attacked anyone? *

Where did you originally get the pet(s)? *

How long have you had the pet(s)? *

If this pet was adopted from another rescue/shelter or acquired from a breeder: did you contact them to see if they will accept the pet back? *

Can the pet(s) easily be caught, picked up or carried, or generally handled? *

How does the pet(s) do with other animals? *

How does the pet(s) do with children? *

Does the pet(s) live indoors or outdoors? *

When are you needing to rehome the pet(s)? *

Does the pet have any past or current medical concerns or conditions? *

Is there anything else we should know about the pet(s)? *

Photo of Pet(s) *

Depending on resolution and size of the image, you may reach the maximum file size allowed for this form. If this happens, please email the remaining images to: info@fairhumane.org