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Please note that the completion of this form does NOT guarantee that your animal will be admitted into the adoption program at SICSA. 

Guardian Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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Animal Information
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Please be as specific as possible.
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(Approx.)
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Please write "None" if your animal is not taking any medications.
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Please write "None" if animal does not have behavior issues.
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Please write "None" if animal does not have any medical issues.
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(mm/dd/yyyy)
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Terms and Conditions

I understand that:

  1. The completion of this form does NOT guarantee that my animal will be admitted into the adoption program at SICSA.
  2. After I submit this form, a SICSA intake specialist will contact me within ten (10) business days to discuss the information I have provided and to schedule a behavior evaluation and physical exam.
  3. All animals must complete a behavior evaluation and veterinary evaluation prior to being considered for or admitted into the adoption program.
  4. All animals are assessed a $15-25 veterinary evaluation fee that is applied to the total surrender fee. The total cost for surrender is typically $25-150 depending on the animal's age and past veterinary care.
  5. SICSA's Intake Department hours are limited. Intake volunteers are typically in the office Monday, Tuesday, Wednesday, and Friday from 12-4 pm. 
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