Animal Surrender Form

Date Date / MM / DD YYYY
Dog Owners Name Dog Owners Name First Last
Animal Owner's Phone Animal Owner's Phone - ### - ### ####
Animal Owner's Email
Animal Owner's Address Animal Owner's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Witnesses Name Witnesses Name First Last
Witnesses Address Witnesses Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Animal Information
Animal's Name Animal's Name First Last
Age
Sex
Color
Animal Type
Years Owned
Spay/Neutered
Weight (lbs.)
Indoor/Outdoor Animal
Last Veterinarian Visit Last Veterinarian Visit / MM / DD YYYY
Veterinarian's Name Veterinarian's Name First Last
Vetrinarian's Phone Vetrinarian's Phone - ### - ### ####
Previous Owner Previous Owner First Last
Please explain why you are surrendering your animal.
Terms and Conditions

By signing this form, I state that I am the owner of the animal that is the subject of this Animal Surrender Form. To my knowledge, no other person has any right to this animal. I hereby surrender all rights to the animal. I understand that once I relinquish the animal, the animal will not be available to be returned.
I have read, understand and agree to the terms of this Animal Surrender Form.
Owner Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Witness Signiture

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Animal Surrender Form

Animal Surrender Form

Animal Information

Terms and Conditions