Pet Surrender FormPlease complete one form for each pet to be surrendered. You may complete the online form below Your Name * First Name Last Name Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email Are you over the age of 18? * Yes No Was your pet adopted from the Humane Society of Yates County or another Shelter? * No Yes, Other Shelter Yes, The HSYC Are You a Yates County Resident? * No Yes Is your pet friendly? * No Yes Does the animal liked to be touched? * No Yes Species * Cat Dog Other Breed * Male or Female * Male Female REASON for Surrender * How Long Owned? * Pet is * My own pet A family member's pet A stray Other Pet is * Spayed/Neutered Not Spayed/Neutered Not Sure if Spayed/Neutered Pet has * Up-to-Date Shot Record No Shot Record Unknown Medical History Approximate age or date of birth, if known * Your best guess is fine if you are not sure Additional Information Thank you! You can also email us PHOTOs of the pet(s) you need to surrender at contacthsyc@gmail.com