L.E.A.S.H. Please enter the information requested below.When you have completed all of the required fields of the form, click submit one time to send your request to Animal Services. We will get back to you as soon as we can. You will need to have a photo of your pet available if you want to surrender an animal. All fields below must be complete before sending the request so that we can better serve you. Due to very high volume, the current surrender appointment wait time can be as long as 30 days. Please note: This service is provided only to residents of Osceola County, Florida. To help us care for your surrendered pet, a donation of $20 at the time of surrender would be appreciated. Please do not submit more than one copy of each request as it slows our processing.Last name*First nameStreet Address*City*choose oneBuena Ventura LakesCelebrationIntercession CityKenansvilleKissimmeePoincianaSt Cloudother (please fill in)Osceola County city not listed*Zip Code - 5 digits onlyEmail Enter Email Confirm Email PhoneI would like to*choose oneget help with dog or cat foodget help with veterinary needs (spay/neuter)surrender my animal(s)otherOther - please explainMy current living situation is*choose oneI have a stable homeI am pending an evictionI do not currently have a homeI would rather not say Proof of eviction is required before or during the appointment. If not available for upload below, please bring a hard copy to the appointment (possible chance of appointment cancellation/denial if not present). I will (please select one) bring the eviction paperwork with me to the appointment. upload the eviction paperwork here. Upload eviction evidence here (optional) File uploadWe have a limited supply of pet food on hand at the shelter. Please send us the food request and, if the pet food that you are looking for is currently available, a Pet Retention Specialist will contact you by either phone or email for a pick up date and time.Reason for surrender (please explain)*Admin only To acquire financing for pet medical needs, click the link below to go to ScratchPay, a program available at six participating area veterinarians. Should you choose this option, you will not need to submit this form. ScratchPay Link Veterinary services at a discounted rate are often available through the Pet Retention office. Please click Submit below to send us a request for information. Shelter administrationMethod of contact*choose onetelephoneemailshelter visitContacting employee*Client has an email address.*yesnoShelter to client contact date* Date Format: MM slash DD slash YYYY Time of contact* : HH MM AM PM Shelter to client final contact date Date Format: MM slash DD slash YYYY Final appointment outcomeOpenNo call/no showAppointment no longer needed: found other optionsShowedCalled and cancelledOutcome notesHelp with dog or cat foodType of food requestedchoose onecat - cannedcat - drydog - canneddog - dryQuantitychoose onesmall bag drylarge bag dry5 cansCompleted food requestschoose one12340 - resolved by clientexceeded maximum assistanceDate of pickup Date Format: MM slash DD slash YYYY Time of pick up : HH MM AM PM Outcomechoose oneresolved by clientshelter provided servicesreferred to other resourcesnon responsive to contactno showHelp with medical/spay/neuterOutcomechoose oneresolved by clientshelter provided servicesreferred to other resourcesDateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Animal surrender informationNumber of animals to be discussed*123Animal 1Animal 1 species*catdogblank field for other type of animalAnimal 1 size*small (less than 20 pounds)medium (21 - 40 pounds)large (41 - 60 pounds)extra large (61 + pounds)Animal 1 gender*femalemaleAnimal 1 spayed*noyesAnimal 1 neutered*noyesAnimal 1 age*baby, still nursing (puppy/kitten)young (age 1-3 years old)middle age (4-7 years old))senior (8 years and older)Animal 1 temperament/personality* Select All good with dogs/cats good with dogs good with cats good with small animals good with small children none of the above choose all that applyHas animal 1 ever bitten anyone?*choose oneyesnounknownDoes animal 1 have any known medical issues?*choose onenoyesExplain animal 1 medical issues.Animal 1's name*Animal 1 photo*Submit photo here Dog breed 1*(ex: beagle, labrador, poodle etc)Animal 2Animal 2 species*catdogblank field for other type of animalAnimal 2 size*small (less than 20 pounds)medium (21 - 40 pounds)large (41 - 60 pounds)extra large (61 + pounds)Animal 2 gender*femalemaleAnimal 2 spayed*noyesAnimal 2 neutered*noyesAnimal 2 age*baby, still nursing (puppy/kitten)young (age 1-3 years old)middle age (4-7 years old))senior (8 years and older)Animal 2 temperament/personality* Select All good with dogs/cats good with dogs good with cats good with small animals good with small children none of the above choose all that applyHas animal 2 ever bitten anyone?*choose oneyesnounknownDoes animal 2 have any known medical issues?*choose onenoyesExplain animal 2 medical issues.Animal 2's name*Animal 2 photo*Submit photo here Dog breed 2*(ex: beagle, labrador, poodle etc)Animal 3Animal 3 species*catdogAnimal 3 size*small (less than 20 pounds)medium (21 - 40 pounds)large (41 - 60 pounds)extra large (61 + pounds)Animal 3 spayed/neutered*femalemaleAnimal 3 age*baby, still nursing (puppy/kitten)young (age 1-3 years old)middle age (4-7 years old))senior (8 years and older)Animal 3 temperament/personality* Select All good with dogs/cats good with dogs good with cats good with small animals good with small children none of the above choose all that applyHas animal 3 ever bitten anyone?*choose oneyesnounknownDoes animal 3 have any known medical issues?*choose onenoyesExplain animal 3 medical issues.*Animal 3's name*Animal 3 photo*Submit photo here Dog breed 3*(ex: beagle, labrador, poodle etc)Kittens or puppiesIf kittens or puppies, is mother being surrendered also?yesnoMore owner detailsHow long have you had the animal(s)?*choose one1 week or less1 to 2 weeks2 - 4 weeks2 - 3 months4 months to 1 year1 - 2 years3 - 5 years5 + yearsReason(s) for concern - click all that apply* allergies behavior citations cost of food cost of vet care has too many pets insurance moving conflict with others pending eviction homeless no time for care no longer want animal Other reasonIf moving, why can't pet(s) go?landlord does not allowno spaceHow can we help you keep your animal(s)?*Surrender necessary*choose onenoyesAppointment for surrenderStaff member making appointmentReason for no surrenderDate of appointmentMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time of appointment for surrender : HH MM AM PM Email confirmation of appointment?noyesAdditional appointments required.none12Additional Appointments InformationDate of appointment 2Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time of appointment for surrender 2 : HH MM AM PM Info appt 2Date of appointment 3Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Time of appointment for surrender 3 : HH MM AM PM Info appt 3Surrender outcomechoose oneresolved by clientsurrendered to shelterreferred to other resourcesnon responsive to contact/no showeuthanasia deemed necessaryPhoneThis field is for validation purposes and should be left unchanged.