If you prefer mailing the application instead of using the online submission method, you may complete the form below, print it, and mail it to SCMR at: SCMR; P.O. Box 355; Hixson, TN 37343. Downloadable PDF and MS Word versions of the form will be available soon.

Please tell us about you:

Owner name(s):

Home address:

Mailing address (if different):

Home phone:

Work phone:

Email address:

What is the best time and method to contact you?

Please tell us about the pet(s) you wish to surrender:

Pet name(s):

Pet D.O.B. :

Pet age(s):

Pet breed(s):

Sex:  Male  Female  Multiple pets (male and female)

If surrendering multiple pets (both male and
female), please specify the sex of each pet below:

Is the pet altered (spayed or neutered)? Yes  No

If surrendering multiple pets (some altered
and some not), please specify the spay/neuter
status of each pet below:

What is the weight of the pet? (If surrendering more than
1 pet, please provide weight for all pets.)

What is the color of the pet? (If surrendering more than
1 pet, please provide colors for all pets.)

Please describe any distinguishing marks:

Are registration papers available? Yes  No

Please provide any additional comments regarding registration papers below:

Name and phone number of the pet's veterinarian:

Date of last vaccinations:

DHLPP:
Rabies:
Heartworm check:

What brand of food does the pet eat? How many times daily? What time? How much?

Where does the pet stay during theday?

Where does the pet stay at night?

Where does the pet sleep?

Does the pet....? (check all that apply)

 Like to ride in cars
 Let you take toys away
 Urinate when scared
 Come when called
 Growl at strangers

Please provide any additional information you feel is necessary regarding your answers to the last question:

Is the pet....? (check all that apply)

 Afraid of storms
 Used to children
 Good with children
 Good with cats
 Good with dogs
 Used to being groomed
 Crate trained
 House trained
 Obedience trained

Please provide any additional information you feel is necessary regarding your answers to the last question:

What commands does he/she know?

Has the pet ever growled at or bitten anyone?

 Yes  No

If Yes, please explain:

What does the pet like and dislike?

What are the pet's best qualities?

What are the dog's worst qualities?

Please provide any other information that might
be helpful for the pet's new family:

Why are you giving up the pet?

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