Litter Surrender ApplicationPet Owner InformationPet Owner Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone (please include area code)*Are you the owner of the pet(s)?* Yes No If not, what's your relationship with the owner?Have you adopted from, donated to, or surrendered another animal to Wayside Waifs in the past?*-YesNoWhat is the main reason you are surrendering this litter?* Too many pets Can't afford Relationship changes (divorce, separation) Can't afford Temporary placement needed No time/overwhelmed Housing Took ownership w/out intent to keep Owner intended euthanasia Pet's appearance, breed, and/or size Allergies Death of owner Health of owner How long can you safely care for this litter?Litter's Description/InformationWhat species is this litter?* Dogs Cats Other What breed is this litter (best guess if unknown)*How many animals are in this litter?*Date this litter was born (best guess if unknown):* Month Day Year Where did you originally get this litter (ex: born at home, friend, found stray)*Maternal informationDo know who the mother is? (If no, skip to Paternal Information)*-YesNoMaybeIf yes, do you own the mother? Yes No If you own and are keeping the mother, are you interested in spay resources?YesNoMaybeWhat breed is the mother?Size prior to pregnancy?Small (under 20lbs)Medium (20-45lbs)Large (over 45lbs)AgeDuring her pregnancy she was: Healthy Sick Skinny Stressed Calm Abnormally aggressive Did she receive consistent meals? Yes No Unknown How would you describe her personality before pregnancy? (gentle, friendly, nervous, aggressive, etc.)Paternal informationDo you know who the father is? (If no, skip to Household Safety/Wellness Information)* Yes No Maybe If yes or maybe, do you own the father?-YesNoIf you own and are keeping the father, are you interested in neuter resources?YesNoMaybeWhat breed is the father?Size:Small (under 20lbs)Medium (20-45lbs)Large (over 45lbs)How would you describe his personality? (gentle, friendly, nervous, aggressive, etc.)*Household Safety/Wellness InformationHas anyone ever threatened to harm/harmed your pet(s)?*-YesNoHas anyone ever threatened to harm/harmed you?*-YesNoDo you feel safe in your home?*-YesNoPlease upload (1) image of the litter. Image should be in focus and show the animals face and body.Max. file size: 50 MB.Upload imageCommentsThis field is for validation purposes and should be left unchanged.
