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Surrender Form for Small Animal/Bird/Reptile

This form is ONLY for: Rabbits, Guinea Pigs, Reptiles, Birds and other Small Animals needing a new home.

NOTE: This form is NOT to be used for cats needing homes. We are able to email you a list of cat rescues that may help. Please call us directly (610-970-7500) to receive the 'cat rescues' list.

Full Name

Phone Number

Email Address

Street Address

City/State/Zip

Please give a description of the Animal, including name, species, age, color, weight, if able to be handled, food requirements, etc. (Provide as much information as known.)

Will an appropriate enclosure also be provided?

Describe the enclosure type/size that will be provided:

Is the enclosure provided in good condition?

Reason you can no longer keep this pet:

How long have you owned this Animal?

Please upload a photo or photos of your Animal.

If we are unable to take in your pet, we will place your pet on a waiting list. If this is an urgent placement, please call our number at 610-970-7500 extension 1 after completing the surrender form.

Animal House Retail for Rescue has generously agreed to assist you in the placement of your pet into a new home/family. The terms of this agreement are as follows: Once the pet is surrendered to our rescue, you understand that you are giving up all the rights to this pet. If for any reason, Animal House Retail for Rescue decides to no longer assist you in the placement of your pet, you agree to take the animal back into your possession within 24 hours of being notified.

Signature:

Signature