Surrender Request - Humane Society of Jefferson County

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W6127 Kiesling Rd | Jefferson, WI 53549

Phone: (920) 674-2048

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Surrender RequestSam Maurice2025-12-02T15:26:37-06:00

Surrender Request

Please fill out this form in as much detail as possible. Once the form is submitted we will contact you within three business days to go over the next steps.

Name(Required)

First Last

Phone(Required)

Email(Required)

How do you prefer to be contacted?(Required)

Phone

Email

No preference

Address(Required)

Street Address Address Line 2 City State ZIP Code

What type of pet do you need to rehome?(Required)

Cat

Dog

Rabbit

Guinea Pig

Bird

Other

Pet's Name(Required)

Pet's Breed or Physical Description(Required)

Pet's Age or Date of Birth(Required)

Pet's Gender(Required)

Female

Male

Unsure

Is the pet spayed or neutered?(Required)

Yes

No

Unsure

Is the cat declawed?(Required)

No

Yes, front paws only

Yes, all four paws

Why do you need to rehome this pet?(Required)

Where did you originally acquire this pet?(Required)

Breeder

Pet Store

Found Stray

Friend/Family Member

Shelter/Rescue

Other

Shelter's Name(Required)

Shelter's City/State(Required)

How does this dog react to other dogs?(Required)

How does this dog react to unfamiliar people?(Required)

Does this cat reliably use the litter box? If not, please explain the circumstances, including how often it happens, where it happens, if there are any recognizable triggers, and whether they've been seen by a vet for the issue.(Required)

Has this pet ever nipped, snapped, or bitten a person? If yes, please explain what happened and whether the skin was broken.(Required)

Please tell us about the pet's personality and needs:(Required)

Is there anything we could assist you with that would enable you to keep this pet?(Required)

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W6127 Kiesling Rd
Jefferson, WI 53549
(920) 674-2048
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