Owner Surrender Form

Wiggle Butts Rescue, Inc. Owner Surrender Form
Full Name

First NameLast Name
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Animal Surrender Form.I cerify that no other person has a right of property to the animal(s). I understand that by surrendering my property rights to the animal, th animal has/has not bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and undertsand the terms of the animal surrender form.
Please Initial
Date

MonthDayYear
Please Select

CatDog
FemaleMale
Age
Breed
Should be Empty:

Wiggle Butts Rescue, Inc. Owner Surrender Form