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2. Important Notice!

   Please call the shelter at 706-769-3956 to verify owner surrender procedures and available space before setting an appointment time and filling out this form!

4. Appointment Date & Time*
   Appointment Date & Time

   Appointment Date & Time
5. Animal Name*
6. Animal Breed(s)*
7. Animal Age*
9. First Name*
10. Last Name*
12. Email*
13. Phone Number*
14. Secondary Number
16. Address*
18. City*
19. State*
20. Zip Code*
22. How long have you had this dog?*
24. How was the dog kept during the daytime?*

    1. Indoors
    2. Outdoors
    3. Both Indoors and Outdoors
26. How was the dog kept during the night?*

    1. Indoors
    2. Outdoors
    3. Both Indoors and Outdoors
28. How does the dog act towards men?*
30. How does the dog act towards women?*
32. Did the dog live with children?*

    1. Yes
    2. No
33. If so, how does the dog act towards children?
34. Ages of children:
36. Is the dog friendly with other dogs?*

    1. Yes
    2. No
    3. Unknown
38. Is the dog friendly with cats?*

    1. Yes
    2. No
    3. Unknown
40. Does this dog chase or harm any livestock animals? Ex: chickens, goats*
42. Does this dog chase or harm any small creatures? Ex: rabbits, squirrels*
44. Is the dog housebroken?*

    1. Yes
    2. No
    3. Partially Housebroken
    4. Unknown
46. Does the dog exhibit resource guarding? Ex: Guards toys or food*

    1. Yes
    2. No
    3. Unknown
48. Does the dog play with toys?*

    1. Yes
    2. No
    3. Unknown
50. Does the dog walk well on a leash?*

    1. Yes
    2. No
    3. Unknown
52. Is the dog obedience trained?*

    1. Yes
    2. No
    3. Some Training
    4. Unknown
54. Does the dog escape? Ex: Digging out, climbing, dashing out doors*

    1. Yes
    2. No
    3. Unknown
56. What brand of dry food does the dog eat?*
58. Does the dog have any other specific behaviors or issues?*
60. Why can you no longer care for this dog? *
62. Additional Comments:
64. Veterinarian:*
66. By signing below, I certify that I realize by surrendering my pet to Oconee County Animal Services it becomes the property of the county.
68. By signing below, I certify that this animal has not bitten or scratched any person within the last 10 days.
70. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
72. First Name*
73. Last Name*
75. Electronic Signature*
Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit Submit and Print

* indicates a required field