First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone*

Cell Phone*

Alt Email*

List the name(s) of the dog(s) or cat(s) being surrendered*

Why are you surrendering them?*

Where did you get them? (Many rescues require you to return the pet to them in the event of a surrender. What does your contract require?) *
Choose one: Breeder Newspaper/Internet Ad Family/Friend Found-stray Pet Store Rescue Group Shelter Other

If adopted through a rescue/society or shelter, list their name and phone number.

Are you willing to foster with the CPS Community Foster Program?*
Choose one: Yes No I don't know

The Community Foster Program is essentially a partnership between you and Cabarrus Pets Society. CPS will become the legal owner and will provide all the food and medical care for the animal(s) while you continue to provide a safe and loving home . We will work together until the animal(s) is adopted into safe, and appropriate permanent home(s) but we have no way of knowing how long it will take to find a new home and it could be days or even months.

Is it a stray? (If yes, contact local animal control & have it scanned for a microchip)*
Choose one: Yes No

If you find a stray

1. Always consider your safety and the animals
2. No matter how they behave or look, assume they are owned and loved by someone
3. Contact local animal control-it’s the law!
4. Check for ID tags, tattoos and have it scanned for a microchip.

Sex:*
Choose one: Female Male

Is it a *
Choose one: Cat Dog

Breed?*

How old is the dog or cat? (in years)*
Choose one: 0 - 2 3 - 5 6 - 8 9 - 11 12 - 15 16 +

How long have you owned? (years)*
Choose one: 0 - 2 3 - 5 6 - 8 9 - 11 12 - 15 16 +

Is the animal spayed or neutered?*
Choose one: Yes No I don't know

Current weight in pounds (approximate is OK)*
Choose one: 0 - 10 11 - 20 21 - 40 41 - 60 61 - 80 81 - 100 101 - 130 131 plus

Is the animal micro-chipped?*
Choose one: Yes No I don't know

Primary coat color(s)
Choose all that apply: Black Brindle Brown Fawn Gray Orange Sable Tan White

Secondary coat color*
Choose one: Black Brindle Brown Fawn Gray Orange Sable Tan White

The coat length is*
Choose one: Short Medium Long

For Cats Only- Is the cat declawed?
Choose one: Yes No I don't know

Primarily lives*
Choose one: Both inside and outside Inside Outside Outside in a fenced area Outside on a chain or leash

If they are kept outside please describe their area

Please list all current pets in your household, including name and type of animal (e.g. Sparky, dog). If none, please type "none".*

Please list any other pets you have owned in the past 10 years, including name and type of animal. If none, please type "none".*

List the name and phone number for the veterinarian that cares for your animals

The veterinary records are under what owner's name and phone and phone number? (If not sure list all possibilities)

We call all veterinarians and review all medical records as part of the Surrender Application Process. If the animal is a stray, contact your local animal control first and have them scanned for a microchip.

Are the vaccines up to date?*
Choose one: Yes No I don't know

Has the dog or cat had any of the following medical conditions in the past or currently?
Choose all that apply: Glaucoma/Cataracts Diabetes Heart Disease/Murmur Kidney Disease Urinary Stones/Infections

Any surgeries, injuries or other medical problems not listed above?*
Choose one: Yes No I don't know

If yes, please explain:

List any medications and/or special foods requirements

Know any commands? (to select more than 1 hold down the shift key while selecting)
Choose all that apply: Beg Come Crate Down Go Potty Leave it Off Rollover Shake Sit Speak Stay

House trained or litter box trained? *
Choose one: Yes No I don't know

Their energy level is best described as*
Choose one: High Medium Low

How would you describe the pet?
Choose all that apply: Constant companion Destructive Easy going Friendly Lap pet Obedient Quiet Talkative

Any separation anxiety? If yes, please explain*

Are they protective of your home or family?*
Choose one: Yes No I don't know

If yes, please explain

How do they respond to strangers? (to select more than 1 hold down the shift key while selecting)
Choose all that apply: Barks at first then okay Doesn't care Everyone is a friend Good once they know them Runs and hides Shy Will bite

When visitors come to your home the pet(s)*
Choose one: Have to be put away Is social and friendly Is unsocial and unfriendly

Are they protective over food, bedding, toys, etc? If yes, please explain

Any of the following behavior issues? (to select more than 1 hold down the shift key while selecting)
Choose all that apply: Biting/Aggression Chew plants Chew electric cords Climb curtains Escaping Jumping on counters Scratch furniture/other things Spraying or marking Other

If yes, please explain:

Any grooming issues? Feet? Ears? If yes please explain.*

Have they lived with or been around dogs?*
Choose one: Yes No I don't know

What was the reaction towards them? (to select more than 1 hold down the shift key while selecting)
Choose all that apply: Afraid or fearful Aggressive Chases them Does not mind Dominant Playful Submissive

Have they lived with or been around cats?*
Choose one: Yes No I don't know

What was the reaction towards them? (to select more than 1 hold down the shift key while selecting)
Choose all that apply: Afraid or fearful Aggressive Chases them Does not mind Dominant Playful Submissive

Have they lived with or been around livestock, rabbits, or birds?*
Choose one: Yes No I don't know

Describe their reactions and behaviors towards men and women? Do they prefer males only or females only? Does long hair, glasses, facial hair or other characteristics trigger responses. *

How are they around children? (to select more than 1 hold down the shift key while selecting)
Choose all that apply: Afraid or fearful Aggressive Does not mind Friendly Ignores Other Playful

Have they ever bitten, snapped at, attacked, or shown any signs of aggressive behavior with children, adults and/or other animals? Please explain*

Had any obedience training?*
Choose one: Yes No I don't know

Do they beg for food or counter surf? If yes, please explain

Walks well on a leash?
Choose one: Yes No I don't know

Would they run away if unleashed?*
Choose one: Yes No I don't know

Have they jumped over or dug under a fence?
Choose one: Yes No

Is pet suitable for a home without a fenced yard?*
Choose one: Yes No I don't know

Is pet suitable for an apartment?*
Choose one: Yes No I don't know

Any fears?
Choose all that apply: Baths Children Fireworks Men Other Rain Thunder Vacuum Women

Crate training*
Choose one: Uses crate regularly Some experience No crate experience

How much freedom do they have?*
Choose one: Free roam Limited to certain areas

How much time are they alone during the day?*
Choose one: 0 --3 hours 4 --8 hours 9+ hours

When you leave the house they are
Choose all that apply: Crated Chained outside Loose in the home Outside in a fence Outside in a kennel Outside in the yard Restricted to certain rooms

When left alone they
Choose all that apply: Bark Chew on furniture/personal items Cries Scratches on doors or windows Urinates/Defecates Is fine

Describe what the best home environment would be*

How did you hear about Cabarrus Pets Society?*

Cabarrus Pets Society’s Surrender Program requires photos of the dog or cat with your application.

The photos must be emailed to CABARRUSPETS@GMAIL.COM.  We will not evaluate your pet(s) or review your application until we receive the photos.

After we receive the required photos, we will review your application and let you know the next steps and options available.

Important : Reviewing your application and evaluating your animal(s) does not guarantee acceptance into our Community Foster Program