HAINES ANIMAL RESCUE KENNEL

www.harkalaska.org I (907) 766-3334

Surrender of Animal Agreement

Owner Iformation

Name

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

Witness (Print & Signature)

Clear

Date

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

Clear

Date

Witness (Print & Signature)

Clear

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: