Animal Surrender

By signing this form, I state that I am the owner of the animals(s) who is/are the subject of this Animal Surrender Form, hereninafter referred to as "the animal". To my knowledge, no other person has any right to this animal. I hereby surrender all rights to the animal. I understand that once I relinquish the animal, the animal will not be available to be returned. I have read and understand the terms of this Animal Surrender Form.

Owner's Name*

First NameLast NameSuffix

Phone*

Area CodePhone Number

E-mail

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Date of surrender*

Date

Owner's signature*

Name*

Breed*

Type*

DogCatOther

Color*

Sex*

MaleFemaleUnsure

Spay/Neutered*

YesNoUnsure

Obtained ownership*

Previous Owner

Current Vet

Last vet visit*

Date

Last Rabies vaccination*

Date

Explain in detail why you are surrendering this animal.*

List any known health issues.*

List any known behavioral issues.*

The animal is being surrendered to Rescue Revolution, a 501(c)3 nonprofit animal rescue.

I hereby certify that I am the rightful owner of the animal and/or have the authority to surrender the animal who is the subject of this Animal Surrender / Intake Form, hereinafter referred to as “the animal.” I will at all times indemnify Rescue Revolution, including its officers and fosters, from and against any loss (including reasonable legal costs and expenses) or liability incurred arising from any claim, demand, suit, action or proceeding by any person where such a loss or liability arises from surrendering the animal (for example, if you are not the owner of the animal, or own the animal jointly with others who have not consented to the surrender). I agree that Rescue Revolution may contact me regarding anything occurring or stemming from information excluded, whether deliberate or unknown, from the above provided information, such as a pre-existing health condition or incident stemmed from known aggression trigger. I hereby surrender all ownership rights to the animal and transfer the animal and its full custody to Rescue Revolution. I authorize Rescue Revolution to access/obtain all necessary records including vet records. I understand that once I relinquish the animal, the animal will not be available to be returned. Any donations, including items relinquished with the animal, are non-returnable and nonrefundable as they will be used towards the care and cost associated with caring for the animal.

By signing/submitting this form, I certify that I have read and understand the terms of this Animal Surrender / Intake Form and permanently and irrevocably surrender ownership of the animal, with all rights, to Rescue Revolution.

Please consider making a donation to help us continue to save lives and find forever homes for animals such as the one you are surrendering today.

Please provide a clear image of the animal you are surrendering.

Browse Files

ANIMAL SURRENDER FORM

ANIMAL INFORMATION