Surrender Application Does the OWNER of the pet currently have or have they recently passed from a documented terminal illness? (Documentation may be requested)* Yes No Does the OWNER of the pet reside in El Paso or Teller county, Colorado?* Yes No Was the pet previously adopted from Safe Place for Pets?* Yes No Who can we contact about this pet?Name* First Last Phone*Email Relation to pet owner?* Relative Friend Pet Owner Pet Description: Type of Pet:*Name:Age (approximate):Sex: Male Female Is pet spayed or neutered? Yes No Unknown Is the pet up-to-date on vaccines/ have a current wellness exam (Documentation may be required)? Yes No Unknown Does pet have any medical issues/special needs requiring medications, prescription food, etc? Yes No Unknown If Yes, please describe:Is pet reliably housebroken/litter box trained? Yes No Unknown Does pet have any behavioral or aggression issues? Yes No Unknown If Yes, please describe:Is It Safe For The Pet To Live With Children Or Other Pets?Cats Yes No Unknown Dogs Yes No Unknown Kids Yes No Unknown How long can pet stay where it is (safely)? This iframe contains the logic required to handle Ajax powered Gravity Forms.