Owner Surrender Request

Surrender Agreement

Owner/caretaker's name:*

Full Legal Name

Address/ City/ State/ zip code:*

Email Address:*

Home phone number:

Cell phone number:*

Please give a brief description of the pet, including: name, breed, age, color, weight, etc.*

How long have you owned this pet?*

Is this pet current on vaccinations? (We will require proof prior to entering RCR's adoption program of any vaccines or medical history. Lack of current vaccination does not disqualify the pet from our program.)*

YesNoI am not certain

How is your pet with people?*

Is your pet spayed or neutered?*

YesNoI’m not sure

How is your pet with other animals?*

Has your pet ever bitten a person?*

NoYes

Does the pet have any health problems or is currently on medication?*

What things would you want a new owner to know about your pet?*

Is there anything else you want to tell us about your pet?

Animal Surrender Agreement

By typing your name into the signature block below you testify the following;

A. To the best of my knowledge, this animal has not bitten anyone within the 10 days immediately prior to the date of surrender and all information about this animal given to Right Care Rescue, Inc. is true.

B. Release and Transfer: the Owner/caretaker hereby relinquishes all present and future rights and claims to the animal. The Owner/caretaker hereby transfers the ownership of the said animal to Righteous Care Rescue, Inc. for the purpose of having Righteous Care Rescue, Inc. search for a new home for the animal. The Owner/caretaker understands and acknowledges that upon execution of this Agreement, the Owner does not have the right to make any future decisions concerning the animal, including, but not limited to medical and adoption decisions.

C. The Owner/caretaker hereby releases Righteous Care Rescue, Inc. from any and all liability arising from the placement for adoption or any other necessary or appropriate action undertaken by Righteous Care Rescue, Inc. on behalf of the animal.

Signature (please use your finger or mouse to sign in the box)*

Date:*

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