Animal Surrender Agreement

I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Animal Surrender Agreement, hereinafter referred to as “the animal.” I hereby surrender any and all property rights to the animal. I certify that no other person has a right of property to the animal.

I understand that by surrendering my property rights to the animal, the animal may be transferred into the custody of an animal shelter or another rescue.

I also hereby certify that within the past 10 days, the animal has or has not bitten or scratched a human or another animal.

Recently Bitten Another

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Owner Information

Name

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Contact Number

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Email Address

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Address

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City, State, Zip

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Animal Information

Name

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Microchip (if available)

Species

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Gender

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Age or Date of Birth

Breed

Color

I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and understand the terms of this Animal Surrender Agreement.

I enter into this agreement in free will and understands the agreement.