H.E.A.R.T. Surrender/Intake Form
By signing this form, I state that I am the current owner of the animal(s) who is/are the subject of this animal intake/surrender form, hereinafter referred to as "the animal". To my knowledge, no other person has any right to the animal. I hereby surrender all rights of the animal to Holliday's Exotic Avian Rescue Team(H.E.A.R.T.). I understand that once I relinquish the animal, the animal will not be returned. I understand I must relinquish the animals belongings(cage, food, toys, etc) to Holliday's Exotic Avian Rescue Team(H.E.A.R.T.) to make the transition easier for the animal. I have read and understand the terms of this Animal Surrender/Intake Form.
Street Address Line 2
State / Province
Postal / Zip Code
Animals Sex(if known):
Animals Previous Vet(name of vet, name of office, address of office and phone number. If none put NA):
Are we allowed to contact your vet for records of the animal? We like to have previous records to see what all they have been treated/tested for.
Reason for surrender:
Will you be dropping off the animal and its belongings or do you need H.E.A.R.T. to pick up?
By signing this form, you understand and have read the terms of this surrender/intake form. To your knowledge, everything has been answered correctly. If you have given H.E.A.R.T. permission to contact your vet for any records you didn't bring, you understand H.E.A.R.T. or their vet will pull records to transfer over to their vets office. By typing your name you understand that you are signing this form virtually and is an electronic signature.
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