Animal Surrender Application

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Please fill out this application to the best of your ability. These answers will not affect your animal from being accepted into our rescue. We just need to learn more about their health, personality, and their life style.

YOUR INFORMATION
First Name:		Last Name:
Address:		City:
State:		Zip:
E-mail:		*Phone:
*Please include area code.

ANIMAL INFORMATION
Can you transport?	Yes No
Animal's Name:		Breed:
Animal's Age:		Color:
Health Issues?	Yes No
If so, please explain:
Training?
Date of last vaccination(s)?
Types of last vaccination(s)?
Date of last worming?
If horse, last time teeth were floated?
Food that is being fed?
Has this animal ever had diseases?
What type of fencing is this animal used to?
Any allergic reactions to anything?
Does this animal have any vices?
If horse, has he or she ever bucked, kicked, reared, bit anyone, or anything?
Please tell us why you cannot keep this animal.
Please enter this text in the box provided.

By submitting this form you are giving up all rights to the above-mentioned animal and you are no longer responsible for the above-mentioned animal which is now officially the property of Heartfelt Animal Rescue.

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