Pet Surrender Form

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This field is for validation purposes and should be left unchanged.

Contact Information

Name(Required)

First Last

Organization (if any)

Street Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your mailing address different from your street address?(Required)

Yes

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Work Phone

Current Veterinarian(Required)

Animal Information

Surrender Date(Required)

Pet's Name(Required)

Species(Required)

Cat

Dog

Sex(Required)

Male

Female

Breed(Required)

Description (i.e. color, size, specific markings)(Required)

Estimated Date of Birth(Required)

Microchip Number

Spayed/Neutered?(Required)

Yes

Not sure

Vaccination & Health Records

Drop files here or

Max. file size: 50 MB.

Behavioral Notes(Required)

Reason for Surrender/Transfer(Required)

Sign and Date

I hereby release the pet named above into the custody and control of Animal Rescue of the Rockies. I declare that I obtained the above animal legally and that I waive all future rights in the ownership or control of the above animal. I hereby agree to transfer all right, title, and interest in the control or ownership of the above animal as of the date below.

Signature(Required)

Today's Date(Required)