Owner Surrender Form

Owner's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email address:*

example@example.com

Phone Number*

Please enter a valid phone number.

Please provide proof of residency in Ascension Parish.*

Pet's Name:*

Canine or feline:*

CanineFeline

Why are you surrendering this pet?*

Where did you acquire this pet If adopted from another shelter/rescue, which one Have you reached out to them?*

How long have you owned this pet?*

Pet gender:*

MaleFemale

Age of pet:*

Is your pet spayed/neutered and can you provide proof?*

Veterinarian name & phone #.*

Any known health issues?*

Breed of pet:*

Color of pet:*

Estimated weight:*

Training:*

Compatability of pet:*

Please share any information you would like to add regarding this pet which may help assist us in finding a suited home for them.

Please provide an updated photo of your pet.*

AGREEMENT:

By surrendering this animal to Cara's House Ascension Parish Animal Shelter, I am relinquishing all

rights of ownership. I understand by relinquishing ownership of this animal, I will not be able to

inquire about or determine the final destination of this animal. I understand that the placement

options include adoption, foster, transfer or humane euthanasia. Cara's House can not guarantee the

outcome of any animal.

I understand that once I surrender an animal to Cara's House Ascension Parish Animal Shelter, I am

not allowed to adopt or foster an animal from Cara's House Ascension Parish Animal shelter in the

future.

To the best of my knowledge, this animal HAS NOT bitten anyone within the past ten (10) days.

I also affirm that I am the legal owner of this animal and have not taken this animal from another

person without that person's consent.

Signature*

Date*

Date