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Digital Courtesy Post Request Form
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Digital Courtesy Post Request Form
Courtesy Post Request
COURTESY POST REQUEST FORM
Date of Request
*
MM slash DD slash YYYY
Owner's Information
Owner Name:
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
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Korea, Republic of
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Nigeria
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Panama
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Poland
Portugal
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Qatar
Romania
Russian Federation
Rwanda
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Virgin Islands, U.S.
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Yemen
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Åland Islands
Email :
*
Phone:
*
Is texting OK?
*
Yes
No
By checking YES above, you agree to receive recurring messages from Humane Society of Sedona; Reply STOP to opt out; Reply HELP for help; Message frequency varies; Message and data rates may apply; Carriers are not liable for delayed or undelivered messages
What have you done so far to rehome your pet on your own? (Check all that apply):
*
Select All
Social Media
Flyers
Friends
Family
Coworkers
HSS Courtesy Post
Adopt A Pet.com Profile
Next Door
Home-to-Home Profile
None of the Above
Other
Why are you surrendering your pet?
*
Pet's Information
Pet's Name
*
Pet's Age
*
Pet's Sex
*
Male
Female
Unknown
Pet's Species
*
Cat
Dog
Other
Pet's Species
*
Breed
*
Weight/Size
*
Spayed/Neutered?
*
Yes
No
Unknown
Microchipped
*
Yes
No
Unknown
How long has your pet lived with you?
*
Upload current picture(s) of your pet
*
Accepted file types: jpg, png, Max. file size: 32 MB.
Upload current picture(s) of your pet
Accepted file types: jpg, png, Max. file size: 32 MB.
Upload current picture(s) of your pet
Accepted file types: jpg, png, Max. file size: 32 MB.
Does your pet get along with other animals?
*
Yes
No
Unknown
What kinds of animals does your pet get along with?
*
What kinds of animals does your pet NOT get along with?
*
If you are surrendering more than one animal, are they bonded?
*
Yes
No
N/A - surrendering only one animal
Does your pet do well with children?
*
Yes
No
Mostly
Unknown
Is your pet potty trained or litter box trained?
*
Yes
No
Mostly
Please describe any medical conditions new adopters should know about:
*
Medications needed, allergies, ongoing treatments, special diet, etc.
Please describe any behavioral issues new adopters should know about:
*
Please describe what your pet enjoys:
*
Petting, walking, hiking, swimming, playing, fetch, snuggling, children, other animals, etc
Please describe what your pet dislikes:
*
What may frighten them: loud noises, children, etc - do they dislike being petted, hiking, water, etc.
Please list any other information you would like to share about your pet:
*
How would you like potential adopters to contact you?
*
Information will be published on our social media pages
Acknowledgement & Agreement
*
By checking this box, I acknowledge, understand, and agree to the following:
1. I am legal the owner of this animal.
2. HSS cannot guarantee the rehoming of my pet and that it is the owner's responsibility to screen potential adopters who respond to the courtesy post
3. I hold HSS harmless for any potential negative outcomes of my animal
4. The disposition of my animal is left entirely to the discretion of HSS and will in no way hold HSS responsible for the final disposition of my animal upon surrender
5. I relinquish the right to obtain any information about this animal as well as any claims to this animal upon surrender
6. I agree to allow the information I have provided to be publicly posted on HSS' social media pages, including personal contact information.
7. I understand that my personal information provided may appear in search engine results and I do not hold HSS accountable for its removal.
Owner's E-Signature
*