Intake Form – Penny & Wild

Name

First

Last

Phone

Email

Address

City

State/Province

Zip/Postal

Date of Birth:

Age:

Are you rehoming a pet or surrendering an animal you found?

A pet

Found animal

Was this animal previously adopted from Penny & Wild Smalls of South Florida?

No

Yes

Will you be fostering until an adoptive home is found?

No

Yes

Are you able to pay the $100* Surrender Fee at this time? *this fee is per animal and is non-refundable

Yes

No

Select Species:

Rabbit

Guinea Pig

OtherOther

Rabbit:

Single

Bonded Pair

Bonded Trio

OtherOther

Guinea Pig

Single

Bonded Pair

Bonded Trio

OtherOther

Rabbit(s) Information

*if multiple rabbits / groups, please specify name, gender, age, breed, weight, who is bonded.

Guinea Pig(s) Information

* if multiple guinea pigs / groups, please specify name, gender, age, breed, who is living together

Upload a picture of the animal(s) being surrendered.

Maximum file size: 516MB

*if multiple submit individual pictures of all

Upload a picture of the current housing / enclosure.

Maximum file size: 516MB

Upload a picture of the supplies you are currendly using:

Maximum file size: 516MB

* include hay, pellets, litter, treats, supplements, toys, etc.

Are they spayed / neutered?

Yes, date / location:Yes, date / location:

No

I don’t know

Do you have a medical record or document certifying that the animal is spayed / neutered?

Maximum file size: 516MB

Have they been seen by a veterinarian in the last 6 months?

Yes. Date of last visit:Yes. Date of last visit:

They have been seen by a vet but over 6 months ago. Date of last visit:They have been seen by a vet but over 6 months ago. Date of last visit:

No, this animal has never been to the vet.

Where?

Upload medical record

Maximum file size: 516MB

Please select all that apply:

Good with other animals (please specify cats, dogs, rabbits, etc.)Good with other animals (please specify cats, dogs, rabbits, etc.)

Good with kids (please specify ages)Good with kids (please specify ages)

Afraid of other animals (please specify)Afraid of other animals (please specify)

Aggressive (please specify if with animals, kids, people, etc.)Aggressive (please specify if with animals, kids, people, etc.)

Medical ConditionMedical Condition

OtherOther

None of the above

To help us make the best possible match with a foster or forever home, please let us know of any habits or needs, good or bad, that we should know about:

I authorize Penny & Wild to request medical records pertaining to the animal(s) from my veterinarian(s).

*write N/A if this animal has never been seen by a vet

I certify that I am the rightful owner of the animal(s) who is/are the subject of this Intake Form and no other person has a right of property to the animal.

I hereby surrender property rights of the animal(s) to Penny & Wild Smalls of South Florida. I understand that once I relinquish the animal, the animal will not be available to be returned or adopted by me and I will not recieve updates on their status at any point.