HAINES ANIMAL RESCUE KENNEL

HAINES ANIMAL RESCUE KENNEL
www.harkalaska.org I (907) 766-3334
Surrender of Animal Agreement
Owner Iformation
Name
Date

MonthDayYear
Date
Mailing address
Physical address
City
State
Zip
Phone (H)
Phone (C)
Email
example@example.com
Should additional information be required is it okay to contact you?
Pet Information
Name of pet
Age
Species
Breed(s)
Gender
Is the animal spayed or neutered
Statment of Surrender
I CERTIFY THAT I do own the animal described above and I herby surrender all of my interest therein to the Haines Animal Rescue Kennel (HARK It is expressly agreed that HARK, its officers, agents and employees will not incur any obligation to me regarding the final disposition, euthanasia or adoption of said animal. All information provided is to the best of my knowledge true and accurate.

To the best of my knowledge, said animal HAS NOT bitten any animal or human within the last ten days.
Signature

Clear
Date

MonthDayYear
Date
Witness (Print & Signature)

Clear
Date

MonthDayYear
Date
HAINES ANIMAL RESCUE KENNEL
www.harkalaska.org I (907)766-3334

The Haines Animal Rescue Kennel (HARK) is a non-kill kennel, however we are not set up as a long term care facility. If HARK determines your animal is not adoptable due to temperament, physical, medical or legal reasons we reserve the right to dispose of your animal through humane euthanasia by injection. If this has been determined by the staff euthanasia will only be performed with HARK board of directors consent.
I, (Print full legal name)
have read the above statement and agree that by surrendering my animal that I must also agree to the terms outlined above. Upon the signing of these documents I also understand and accept that I am waiving any and all rights to this animal and that HARK will become the legal owner of this animal.

In the event that Euthanasia has been decided, please contact me.
Initials
Signature

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Date

MonthDayYear
Date
Witness (Print & Signature)

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Date

MonthDayYear
Date
Animal Profile
Animal Background
How long have you owned this animal?
Where did the animal originally come from?
Why are you giving this animal up?
Animal Training
Is the animal house broken?
Is the animal litter box trained?
Is the animal leash trained?
Does the animal know basic commands ( sit, stay, no, ect)?
Animal Behavior
Has the animal ever bitten or scratched anyone?
Is the animal aggressive towards people/ animals, including food aggression?
Does the animal get along with children?
How does the animal do with other animals?
Does the animal like riding in cars?
How is the animals behavior when left alone?
Any other behavioral traits worth noting?
Medical Background
Date of animals last vet exam?
Date and time of vaccinations the animal has received?
Are there any medical conditions with the animal?
If yes, please describe:
Has the animal ever had a surgery?
If yes, please describe:
Animal Routine
Does the animal live primarily indoors or outdoors?
How much time does the animal spend outside?
What kind of shelter is the animal used to when it is outside?
What type of containment system is used with this animal?
When you leave the animal alone, where does the animal normally stay?
What kind of food has the animal been eating?
What is the current feeding schedule (time of day and proportions)?
Please outline the animals typical daily routine:
Any other information you can provide is very helpful for us to find the right home:
Should be Empty: