Four Roots Ranch Animal Sanctuary
Arrival / Surrender / Transfer Date
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Month
-
Day
Year
Date
Type of Intake
Rescue
Stray
Surrender/Re-home
Sanctuary/Rescue Transfer
NAME OF TRANSFERRING INDIVIDUAL
[hereinafter referred to as [The Guardian]
Name
First Name
Last Name
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Animal(s) Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Animal Information
[hereinafter referred to as [The Animal(s)]
Animal(s) transferring custody
Health Status & Veterinary History
Do you have medical records for the animals? (If so please provide at date of surrender or before. If electronic, please email to kate@fourrootsranch.com)
*
Yes
No
Not applicable
Do the animals have any medical concerns?
Date of last hoof trimming
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Month
-
Day
Year
Date
Date of last shearing
-
Month
-
Day
Year
Date
Any temperamental or behavioral issues we should know about?
None
Surrender Agreement
I hereby certify that I, [The Guardian], am the rightful guardian of the animal(s) who is/are the subject of this Transfer Of Legal Guardianship Agreement, hereinafter referred to as [The animal(s)]. I hereby surrender any and all property rights to [The animal(s)] to Four Roots Ranch Animal Sanctuary. I certify that no other person has a right of property to [The animal(s)]. I have disclosed all material information regarding the medical and behavioral history of [The animal(s)]. I will willfully surrender all medical records and information pertaining to [The animal(s)]. I have granted permission to contact my veterinarian for any necessary information pertaining to [The animal(s)] and I hereby consent to the release of any and all medical information by any medical provider. I understand that once I relinquish [The animal(s)], [The animal(s)] will not be available to be returned and Four Roots Ranch Animal Sanctuary has no obligation to follow up with information about [The animal(s)].I hereby release and forever discharge Four Roots Ranch Animal Sanctuary from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of [The animal(s)], and I agree to indemnify and hold harmless Four Roots Ranch Animal Sanctuary from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties. I have fully read and understand this Transfer Of Legal Guardianship Agreement. I accept and agree to abide by its terms.
Please note once an animal(s) is surrendered, we will provide a follow-up email or text message letting you know they have arrived at our sanctuary safely. We are not open to the public and, as a protocol, don’t allow former owner visits out of the best interest of the animal(s) in our care. We appreciate your understanding.
Guardian Signature
*
Name
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
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