Name:
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Date:
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Animals Name(s):
*
Has the cat or dog ever injured a person?
Yes (explain)
No
Unknown
If Yes to above please explain
Notes/Reason for Surrender
*
Relinquishing Receipt for Animal Surrendered to The Hooff House Rescue and Sanctuary
*
I hereby give The Hooff House permission to request all medical history and medical records from my Veterinarian for the pet I am relinquishing.
I acknowledge that my signature on his receipt relinquishes all claims of ownership of the pet(s) described. I understand that unless otherwise approved by The Hooff House president this pet(s) will not be returned to me, once left in their or any of their foster's care. Neither my family, any representatives acting on my behalf, nor I may assert any claims, or otherwise against The Hooff House Rescue and Sanctuary with respect to this pet(s).
I understand that if I find an adopter for the pet that I must notify The Hooff House Rescue and Sanctuary of this. The adopter must submit an application for approval and pay any applicable adoption fees within one week of notifying The Hooff House.
I acknowledge that once the pet or pets are adopted out I will not get them back and there is no guarantee of updates.
Signature
*
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