Levy County Animal Services

LEVY COUNTY ANIMAL SERVICES

OWNER RELEASE FORM /
I AM SURRENDERING THE FOLLOWING CAT(S) AND/OR DOG(S)

Applicant Information

Name:
Street Address:
City: / State: / ZIP Code: / Phone:

reason for the drop-off

Reason animal(s) brought in:
How long have you had the animal(s)?
Where did you get the animal(s) from?
If animal is a stray, where did you find it?
How long have you had it?
Why don’t you want to keep it?

animal information

(Please provide as much information as you can)

Name: / Sex: M F / Date of Birth:
Breed: / Color: / Size: S M L XL
Name: / Sex: M F / Date of Birth:
Breed: / Color: / Size: S M L XL
Name: / Sex: M F / Date of Birth:
Breed: / Color: / Size: S M L XL
Name: / Sex: M F / Date of Birth:
Breed: / Color: / Size: S M L XL
Is animal spayed / neutered? (Please circle) / Has the animal ever been to the Vet? Yes / No (Please circle)
Reason(s) for the Vet visit?
Vet’s Name:
Is the animal good with: (Please circle) kids / dogs / cats / livestock / horses
Circle any of the following that applies: (Please circle) chewer / digs / scratches /
jumps on people / jumps fences / housetrained / bites people/animals
Any other comments that could assist in finding a suitable home for the animal: (examples: type food, feeding schedule, enjoys grooming/baths, favorite toy/treat)

animals that come to levy county animal control are normally* held 3-5 days before ADOPTION, rescue or euthanasia.

*if staff determines animal is aggressive, INJURED, OR sick could be less

Signature of Applicant: / Date:

OFFICE INFO: KENNEL # ______