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Owner Surrender/ Return to Rescue Form

Please fill out the following information


The information you give us in this form will help determine the best home for your pet. Please make sure all information is

complete and accurate. Forms that are not filled out completely can not be submitted.

Thank you.

**STARS of GA can only accept Owner surrenders if we have foster homes available! 

Owner Name*

Street Address*

City, State, Zip*


Email Address*

Pet's Name

Has this Animal been adopted from Stars*

When was this Pet adopted from Stars?

Type of Pet*


Age of Pet *

Size of Pet*


How long have you had the Pet? *

Previous vet *

Pet is good with*

Has Pet lived *

Is pet spayed/neutered? *

Is Pet current on vaccinations?*

Is Pet Heartworm negative ?*

If this Animal was previous adopted from STARS of GA and is being returned we require a Heartworm test. If the heartworm test is positive YOU DO AGREE TO PAY FOR THE HEARTWORM TREATMENT! *

Has pet ever shown aggression ?*

Additional information about your Pet*

Reason for Surrender*

I am the legal and rightful owner of the above described pet. I voluntarily release and surrender all rights, privileges, and ownership to STARS of GA, Inc. I certify that the information provided on this form is true and correct. I understand that a physical evaluation of the dog, and a temperament test will be performed by an experienced rescue and /or volunteer to ensure we feel the dog is rehomeable beforewe accept this dog into any foster home or a forever home. If during the evaluation process we find that information contained in this surrender form to be false, we have the right to turn down acceptance of the dog you are surrendering.

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