Safe Harbor Farm 

Your name(s)

Address:

E-mail address:

Telephone #1:         Telephone #2:

Pet's name:             Color(s):

Species:        Age:         Sex::  F M

Primary breed:      Secondary breed:

Reason for surrendering pet:

If you are looking to surrender a litter, has an appointment been made to spay the mother yet?     Yes    No   N/A      With which veterinarian?

Has your pet had any obedience training?   Yes   No

Please list any behavioral issues you have with your pet:

Please list any medical issues your pet has:

Date of last rabies vaccine:  Last distemper vaccine:

Date stool sample was last checked for parasites:

(Dogs) Is your pet presently on heartworm preventative?  Yes   No

(Cats) Is your pet leukemia negative?  Yes   No   I don't know

Pet's veterinarian(s):

Veterinarians' phone numbers:  

Does this pet get along with male dogs?  Yes No   Female dogs? Yes No

Does this pet get along with cats?  Yes   No

Does this pet get along with young kids?   Yes No     Older kids?  Yes No

Percentage of time this pet has spent outdoors:    Indoors:

When would you be available to bring this pet to Safe Harbor Farm (in Maysville) for temperament testing? 

To what extent are you willing to help SHF volunteers offset the costs of finding a wonderful, responsible, well-screened new home for your pet? (minimum donation $25)

   Please allow at least 48 hours for application processing before
calling to follow up on your application.
Thank you.