SAVE YOUR ASS LONG EAR RESCUE

Rescue, Rehabilitate, Educate

Intake Profile For Surrender

Animal’s name:______Date:______

Please circle one: Donkey/ Mule /Hinny Male/Female Gelded? Yes/No Age:______

We do not require a surrender fee but if you are able to make a donation toward the care of your animal until it is placed we would be most grateful.

Reason for surrender:

Pertinent History: Please list veterinary history including vaccinations, wormingand date given. Please list any medical conditions your animal has and foot trimming history including date of last trim.

How long have you owned this animal?______

Where has your animal been housed: Please circle: stall, run in, paddock, other. If other, please explain. ______

Please circle yes, no, or U (unknown) Is your animal good with Sheep? Y N U

Goats? Y N U Dogs? Y N U Children? Y N U

Please give a detailed list of what your animals is currently being fed and amounts and times of feeding.______

Please list any parts of his or her body your animal does not like to be touched:

Please list any “quirks” your animal has that we should know about. ______
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Please list anything about your animal that you think will help him or her be adopted:______

Owner Information and Release

Owner’s name______

Address:______

Phone Number:______Email Address:______

To Save Your Ass Long Ear Rescue: I certify that I own the animal described and I hereby surrender all rights, title and interest to Save Your Ass Long Ear Rescue. It is expressly agreed that said organization, its officers and employees, will incur no obligation to me on account of the disposition of this animal. To the best of my knowledge, this animal has not bitten anyone in the past 14 days.

Additionally, I certify that I understand Save Your Ass Long Ear Rescue’s euthanasia policy. I understand that my animal may be humanely euthanized by a licensed veterinarian if found to be unsafe by being aggressive, or has tried to harm any Save Your Ass Long Ear Rescue officer or employee. I also understand that my animal may be euthanized for life threatening illness or disease that jeopardizes the rescue organization’s animal population, or succumbs to psychological distress as a result of living in a rescue situation.

I hereby certify that I understand and agree to the above conditions.

Signature:______Date______