Animal Surrender Form

Animal Surrender Form
(Please consult Andrea before submitting this form. 808-495-1591)

By completing and submitting this form, I acknowledge and accept the fact that I relinquish all future claims of ownership of the surrendered animal.

First Name

Last Name

Date of Animal Placement required

Phone

Location (where animal was found)

Street Address

City

Postal / Zip code

Name of Animal

Animal age, if known, or age range (baby, adult, senior, etc)

Species

Breed (if applicable)

Animal's Veterinarian (if any)

What care was provided to the animal prior to surrender?

Other animal rescue groups I contacted prior to EMAR

Please check the boxes below that apply to this animal:

The animal was raised as a pet.

The animal is tame.

I brought the animal to EMAR.

A representative of EMAR or another organization brought the animal to EMAR.

I declare that the information I’ve provided is accurate and complete. By submitting this form, I understand that I relinquish all current and future claims of ownership of the animal.

Upload animal photo (optional)

Upload File

Upload supported file (Max 15MB)

Thanks for submitting!

​Animal Surrender Form (Please consult Andrea before submitting this form. 808-495-1591)

By completing and submitting this form, I acknowledge and accept the fact that I relinquish all future claims of ownership of the surrendered animal.

Animal Surrender Form
(Please consult Andrea before submitting this form. 808-495-1591)