Hercules' Haven · Animal Surrender Application

Owner/Keeper/Caretaker/Custodian Information

Name

*

First Name

Last Name

Phone Number

*

Email

*

Verify Email

*

Would you like to receive email news and updates about Hercules' Haven?

*

Yes, please add me to your mailing list!

No, thank you.

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

How did you hear about Hercules’ Haven?

*

Surrender Information

Animal Name

*

Species

*

Breed

*

Gender

*

Male

Female

Unknown

Birth Date

*

(enter approximate date if unknown)

Photo of Animal

*

Please describe (in detail) the personality of the animal.

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Does the animal “get along” with other animals and people?

*

Does the animal have any fears of phobias?

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Detail the animal’s diet including type of food, brands and portions.

*

Medical History

Veterinarian Name

*

Veterinarian Phone

*

Veterinarian Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Please detail the medical history of the animal.

*

If selected for residency, we will need copies of medical and vaccination records BEFORE the animal may join us at the Haven. If you already have that information available, please attach it below.

Medical and Vaccination Records

Please attach documents as a single PDF.

Terms & Conditions of Animal Surrender Application

I understand that Hercules' Haven will not pay to rescue an animal. I also understand that Hercules' Haven gives priority to admissions for farm animals referred by local shelters, partner rescues, and to rescue animals from industrial farms. I accept that my submission of this application is in no way a confirmation that my animal will be accepted as a new resident of Hercules' Haven. I agree to respect the intake decision made by the Haven’s Executive Committee as being the best decision for my animal and Hercules' Haven.

Application Confirmation

*

I certify that the information provided in this application is true and have read and agree with the Terms & Conditions of this Animal Surrender Application as stated above.