Transfer Agreement

Owner Surrender Form
You must have pre-approval prior to surrendering an animal.
Do you have preapproval from a Rescue Rehome Repeat representative to surrender this animal?*

YesNo
If you do not have pre-approval, please contact RRR to get pre-approved for surrendering an animal.
Do you understand an owner-surrender fee will apply?*

YesNo
If you have pre-approval, please complete this form.
Date

MonthDayYear
Date
Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Cell Number

Area CodePhone Number
Please describe in detail why you are surrendering your pet.
Animal Information
Name:
Age:
Sex:
Color
Animal Type
Weight/Size
Years Owned
Previous owner
Current Vet
Last Vet Visit
Spay/Neuter
Indoor/Outdoor
Is dog good with other dogs?
Is dog good with cats?
What food is the dog currently eating?
Who has the medical records for this dog?
Do we have permission to obtain those medical records?
To your knowledge, has this dog ever bit anyone?
By signing and executing this agreement, I acknowledge that I am irreversibly relinquishing to RRR of South Louisiana any and all right, title, and ownership that I had or may have had with respect to said animal(s). I further acknowledge that I am the owner of the animal(s) and that I am fully authorized to enter into this agreement. Under no circumstances will the animal(s) be returned to me after this document is signed.
Signature

Clear
Date

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Owner Surrender Form

Animal Information