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JCHS Animal Surrender 

Owner/Animal Surrender Request Form
Choose one to best describe this pet?
My Pet
Stray
Found Animal
What Species is your pet?
Is this animal Female or Male?
Is this animal Spayed or Neutered?
Is this animal House Trained?
Where has this animal lived ?
Does this animal have special needs?
Does this animal require medications regularly?
Is this animal up-to-date on vaccinations?
Has this animal been seen by a Veterinarian?
Yes
No
Has this animal been around kids?
Yes
No
Has this animal been around cats?
Yes
No
Has this animal been around dogs?
Yes
No
Has this animal ever bitten anyone?
Yes
No
Has this animal attacked another animal?
Yes
No
If you are surrendering a dog, please ensure you have completed a behavioral evaluation prior to intake. Should the dog exhibit any signs of aggression, we regret to inform you that, for safety reasons, we will be unable to accept the animal.
Yes
No

15295 K4 Highway, Valley Falls, Kansas 66088

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