RRR Surrender Form

Animal Surrender Form
Name of Dog
Type
Sex
DOB
Breed
Altered
Age Group
Colors
Size
Chip #
Name of Owner
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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 Form, 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 Rosemarie's Rescue Ranch. I also hereby certify that the animal has or has not [select one) bitten or scratched a human or another animal within the past 10 days. 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 Form.

The animal HAS bitten or scratched a human or another animal within the past 10 days. The animal HAS NOT bitten or scratched a human or another animal within the past 10 days.
If "has" was selected, please explain
Signature

Clear
Date

Month Day Year
Date
Should be Empty:

Animal Surrender Form