all my samples were lost on arc.
I, _______________ hereby surrender the following animal to _____________________
Species _________
Age_____________
Color____________
Spayed/Neutered_____________
I hereby surrender my ___________ by the call name of ___________ to __________________________rescue/shelter. I understand that by surrendering my ____________ to ______________ that i am not legally responsible for the ______________ should the animal need to be humanely euthanized for human aggression.
I hereby state that ___________________ has never bitten any human being while in my care.
I state that my veterinarian who took care of ____________ is
Name___________________
Address_________________
Phone __________________
and i hereby give my consent for _______________ to contact my above veterinarian for any medical or any information pertaining to the animal with the call name of ___________________
By signing this statement i hereby relinquish my animal called ______________ which is a ________________dog/cat and i hereby understand that i have surrendered my rights to this animal.
X_______________________-
owners name
X________________________
date
XC_______________________
rescue/shelter