I need to surrender enter number* cat(s) AND/OR enter number* dog(s).
Please list the names and descriptions of each kitten:Name: Description: Name:Description: Name: Description: Name: Description: Name: Description: Name: Description: Name: Description: Name: Description:
If surrendering a mother cat or dog AND her litter, fill out this section with the mother's information.
There is a section at the bottom of this page where information about individual puppies or kittens can be written.
Please accept my surrender fee of $40.00.
I'd like to donate an additional amount to help care for this animal $___.
Total I would like to donate today is $___.
I understand that if I am unable to pay the surrender fee, CHA Animal Shelter may not be able to take the pet(s) I have brought today.
___ By checking this box, I certify that I am financially unable to pay a surrender fee.
I hereby release, unconditionally, the animal described above, to CHA Animal Shelter. I understand that by relinquishing ownership rights of this animal, I will not be able to determine its final disposition. I understand that this animal will either be placed up for adoption or humanely euthanized.
___ By checking this box, I am stating that I want to be contacted in the event that my surrendered animal(s) cannot be placed on the adoption floor as I would like to redeem the animal(s). I understand that this does not guarantee I will be contacted.
I also understand that if I seek to reclaim this animal, I will go through the regular CHA Adoption procedures.
I also affirm that I have not taken this animal from another person without that person’s consent.