Coastal Creatures Animal Surrender Form ​​

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 Owner/Surrendering Party Information 

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Full Name: ____________________________________ 

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Phone Number: ____________________________________ 

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Email: ____________________________________ 

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Address: ____________________________________ 

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City: ___________________ State: ______ ZIP: ___________ 

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 Animal Information 

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Species: __________________________ 

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Name (if known): __________________________ 

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Sex: [  ] Male [  ] Female [  ] Unknown 

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Age (approximate): __________________________ 

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How long have you owned this animal? __________________________ 

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Where did you acquire the animal? [  ] Pet Store  [  ] Breeder  [  ] Rescue  [  ] Wild-Caught   [  ] Other: _____________ 

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 Health & History 

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Has the animal ever been seen by a vet? [  ] Yes  [  ] No 

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If yes, which vet/clinic: _________________________ 

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Any known health conditions, injuries, or special needs? 

___________________________________________________________ 

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Has the animal ever shown aggression or biting behavior? [  ] Yes [  ] No 

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If yes, please describe: _______________________________________ 

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 Habitat & Supplies (if surrendering) 

Are you providing any supplies with the animal? 

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[  ] Enclosure [  ]   Heat source   [  ] Food   [  ] Substrate  [  ] Decor   [  ] Other: ___________________

 

Please list enclosure dimensions and any included items: 

___________________________________________________________ 

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Reason for Surrender

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[  ] Financial hardship [  ] Moving / housing restrictions    [  ] Health of owner 

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[  ] Animal's behavior    [  ] Too many animals 

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 [  ] Other: ___________________________ Brief explanation (optional): 

___________________________________________________________ 

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 Surrender Agreement (Read Carefully) 

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By signing this form, I confirm the following: 

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 I am the legal owner of the animal listed above, or I have full authority to surrender it.

 I understand that Coastal Creatures Rescue & Sanctuary is accepting this animal as a permanent surrender.

I understand that Coastal Creatures may: 

 - Place the animal for adoption 

 - Retain the animal as part of its sanctuary 

 - Euthanize only in cases of terminal illness, extreme suffering, or in compliance with veterinary advice 4. I waive all rights to reclaim this animal once surrendered. 

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 I release Coastal Creatures and its staff from any legal claims related to this animal now or in the future.

 

Signature of Surrendering Party: ________________________________ Date: _______________ Printed Name: ___________________________ 

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For Office Use Only 

Received By (Staff Name): __________________________ 

Date of Intake: _______________ 

Animal Assigned ID #: ____________________ 

Initial Condition: [ ] Healthy [ ] Injured [ ] Emaciated [ ] MBD [ ] Other: ____________ Enclosure Received: [ ] Yes [ ] No 

Entered in System By: ____________________