Your Name: (required)
Your Email (required)
Name of Animal: (required)
Weight
Breed:
Color
Birthdate
Brought in By:
Phone Number:
Date:
Reason for Surrender:
House-Trained YesNo
Current on Shots: YesNo
Vet Office:
Good with Dogs: YesNo
Good with Kids: YesNo
Good with Cats: YesNo
Additional Information:
Dog SpayedNeuteredIntact
Date Altered:
Cat SpayedNeuteredIntact
Please Submit Any Vet Records You Have:
Please Select Any That Apply Separation, Chewing or Other AnxietyChewingExcessive BarkingDiggingInappropriateBeggingProtective of House, Family, EtcBitingAggressionFear of Loud Noises, ObjectsMy Dog had None of these issues Please Explain Any Selected
How does this dog respond to cats, other dogs, strangers, children:
Has this dog ever killed or injured another animal? Please explain
Has this dog been crated trained? YesNo
Can this dog be trusted to be left alone for extended periods? YesNo
Does this dog know any commands? YesNo
If so, explain:
Would it be okay if the new adopters of this dog contact you? YesNo
Please take some time to tell us anything else about this animal that you think we should know or you would like to tell us.
Once you surrender your animal to Battle Mountain Humane Society you are releasing all rights of this animal to BMHS.
We do not allow owners to visit their animal that they have surrendered, due to it is very emotional for the animal.
BMHS is here 100% for the animals. BMHS is for the Homeless and Abused animals only if we accepted your animal. Please understand that your animal will be taking up room until re-homed. You need to be informed that surrendering Your animal to BMHS will have a hard time adjusting. If you change your mind you are more than welcome to come back and adopt your pet at any time as long as well still have the animal. If you are surrendering an animal to BMHS they Run 100% on donations to keep this facility going. We would like to ask if you could make a donation to help care for your pet while in our care until it's adopted.
Do you accept the terms of this agreement? Agree
Check All That Apply: Yes, I would like to sponsor this animal while in your care until adoptedI can sponsor $20 / monthI can sponsor $100 for the animal be fixed and get their vaccination shotsI can pay a designated about amount now and a designated amount every monthI can donate a one time amount
If you elected to pay a designated amount please indicate how much you can donate below:
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