Small Mammal Surrender | Welcome to Wayside Waifs

Small Mammal Surrender Application

Pet Owner Information

Pet Owner Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone (please include area code)*

Have you adopted from, donated to, or surrendered another animal to Wayside Waifs in the past?*

Please list any other name(s) you may have used, if applicable (i.e. maiden name, aliases, etc.)*

Pet's Description/Information

Pet's name:*

Nickname(s) for pet:*

Pet's original name (if adopted from Wayside):*

Species:*

Rabbit
Guinea Pig
Rat
Mouse
Sugar Glider
Ferret
Other

Define "other" species:*

Breed (if known):*

Pet's age:*

Gender:*

Is this pet spayed or neutered?*

How much does this pet currently weigh?*

Describe this pet's color/markings:*

Where did you get this pet?*

If you selected other, please describe:*

How long have you owned this pet?*

If you ARE NOT the 1st/original owner of this pet, what additional information did the previous owner give you (behavior or medical history)?*

Why are you surrendering this pet?*

Pet's Medical Information

Have you ever taken this pet to see a veterinarian?*

Name of animal clinic you use:*

Primary care veterinarian's name:*

Has this pet ever had any vaccinations (that you're aware of)?*

Has this pet seen a vet for anything other than routine vaccinations?*

Please describe the reason(s) for those visits:*

Is this pet on a special/prescription diet?*

Please list the diagnosis/reason for the special diet:*

Please list all medications/supplements that this pet is currently taking and the dosing instructions:*

Pet's Behavior Information

Describe how this pet is housed:*

Is this pet litterbox trained?*

What kind of litter do you use?*

Has this pet lived with other animals?*

What kind of animals lived with this pet?*

Did this pet ever interact with the other animals, and if so how did those interactions go?*

Is this pet bonded (has a very close, almost inseparable relationship) with another pet in the household?*

How long have they lived together?*

Are these animals siblings?*

How does this pet behave when being handled by people?*

Has this pet lived with children?*

How old were the children and how did this pet behave?*

Please feel free to add any additional comments that you think would be helpful for the shelter staff and/or a potential adopter:*

Household Safety/Wellness Information

Has anyone ever threatened to harm/harmed your pet(s)?*

Has anyone ever threatened to harm/harmed you?*

Do you feel safe in your home?*

Please upload (1) image of your pet. Image should be in focus and show the animals face and body.

Max. file size: 50 MB.

Upload Image

Comments

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