• HFHSurrenderAgreement

    Complete this surrender agreement form using the wording from the attached PDF as closely as possible. Fill in the animal, history, vaccination, items, and signature details.
  • Surrendering Owner Information

  • Format: (000) 000-0000.
  • Animal Information

  • Species
  • Sex
  • Spayed/Neutered
  • Reason for Surrender and History

  • Has the animal ever bitten or attacked a person or another animal?
  • Has the animal ever shown aggression?
  • Has the animal ever been diagnosed with any medical conditions?
  • Is the animal currently taking medications?
  • Has the animal ever had surgery?
  • Does the animal have any allergies?
  • Vaccination and Behavioral Information

  • Is the animal vaccinated?*
  • Date of last vaccines
     - -
  • Has the animal been tested for FeLV/FIV (cats) or Heartworm (dogs)?
  • Any known behavioral concerns
  • Optional Items Surrendered

  • Optional items surrendered
  • Signatures and Authorization

  • OWNER CERTIFICATION
    I certify that:
    • I am the legal owner of this animal or have the legal authority to surrender this animal.
    • To the best of my knowledge, all information provided is truthful and complete.
    • I understand that withholding known medical or behavioral information may place people
    and animals at risk.
    • I understand that once this agreement is signed, all ownership rights are permanently
    transferred to the rescue organization.
    • I understand that I relinquish all rights to reclaim the animal, make future decisions regarding its
    care, or receive updates about its placement unless the rescue chooses to provide them.
    • I understand that the rescue may determine the most appropriate course of action for this
    animal, including veterinary treatment, foster placement, transfer to another rescue, adoption,
    behavioral rehabilitation, humane euthanasia if medically or behaviorally necessary, or any
    other decision deemed to be in the animal's best interest.
    • I release and hold harmless the rescue organization, its volunteers, directors, foster homes,
    veterinarians, and representatives from any liability arising from this surrender.

    RESCUE ACKNOWLEDGEMENT
    The rescue agrees to make reasonable efforts to evaluate the animal and provide appropriate
    care based upon available resources. Acceptance of this animal does not guarantee
    placement for adoption and all future decisions regarding the animal shall rest solely with the
    rescue organization.

  • Surrendering Owner Date*
     - -
  • Should be Empty: