I found one
I, ___________________, an adult, do hereby voluntarily and irrevocably give, donate, surrender and release to ________________, hereinafter referred to as _____________________, the following animal(s), hereinafter referred to collectively as "Animal(s)":
Animal(s)' Name(s): _____________________________
Male _______ Female _______ (If multiples, list numbers)
I represent and warrant that I am the lawful owner of the Animal(s), and I have full power and authority to surrender the Animal(s) to CSAC. No other person has any legal or equitable ownership interest in the Animal(s).
I have disclosed to ___________________ all material information regarding the medical and behavioral history of the Animal(s). I willfully surrender all medical records and information pertaining to the Animal(s). CSAC has my permission to contact my veterinarian for any necessary information pertaining to my Animal(s), and I hereby consent to the release of any and all medical information by any medical provider.
Veterinarian's name: ______________________________
Phone Number: ___________________________________
I further acknowledge that I am releasing the Animal(s) completely voluntarily and that no representations, considerations or promises of any kind have been made to me by CSAC or any of its representatives.
List any particular concerns or things ______________________ should know about the Animal(s) -- good and not so good:
I understand that by releasing the Animal(s) to _______________, I relinquish all ownership or other interest in the Animal(s). I will not seek further information about the Animal(s) and will not press _____________ for details. My contact with the Animal(s) terminates at the time of surrender. _________________ is under no obligation whatsoever to follow up with information about the Animal(s).
I hereby release and forever discharge _________________ from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the Animal(s), and I agree to indemnify and hold harmless _____________________ from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties.
This is a legally binding document for the irrevocable surrender of your Animal(s) to _________________________.
I have fully read and understand this Surrender Agreement. I accept and agree to abide by its terms.
OWNER'S SIGNATURE: ___________________________
OWNER'S NAME: ________________________________
OWNER'S ADDRESS: _____________________________
OWNER'S PHONE NUMBER(S): ______________________
OWNER'S E-MAIL: _______________________________
AGENT TAKING CUSTODY:_______________________
There's a fine line between genius and insanity. I have erased this line.