Birthdate: (Must be 18+ Years of age)*
Has your animal ever bitten a person or animal?*
Are you the current owner of the Animal you want to surrender?*
How long have you owned this animal?*
Did you adopt this animal from another rescue or shelter?*
What type of animal are you surrendering?
List any known breeds for your animal: *
Estimated or known weight of the animal: *
Do you know the animals date of birth? (Please list)*
Please Check ALL that apply to the pet you are surrendering:
Is this pet spayed or neutered?*
Up To Date? Most current Vet records required
Current Vet Name:
Vet's Phone Number: (Type N/A if does not apply)*
Please Describe your animal in detail? Personality/temperament, history, training?*
Please Describe Any Current or Past Medical Issues For This Animal in Detail:*
Why do you wish to surrender your pet at this time?*
How did you hear about us?
By signing below I hereby certify that I am the rightful owner/ keeper/ caretaker/ custodian of the animal(s) who is/are the subject of this animal surrender form, hereinafter referred to as “the animal”.
I hereby surrender any and all property rights to the animal and agree this is fully complete and finalized at the time the animal(s) is physically transferred into the care of a Mending Spirits Animal Rescue volunteer, representative or partnering veterinary clinic.
I certify that no other person has a right of property to the animal(s). I understand that by surrendering my property rights to the animal(s), the animal(s) may be transferred into the custody of Mending Spirits Animal Rescue.
I also hereby certify that the animal(s) has not bitten or scratched a human or another animal within the last 10 days, all bite history is disclosed in full that has been inflicted upon any animal or person, and that all history including medical or behavioral issues have been accurately presented and in full.
I understand that once I relinquish the animal to Mending Spirits Animal Rescue, the animal(s) will NOT be available to be returned back to you or anyone other than an appointed Mending Spirits Animal Rescue representative or partnering veterinary clinic.
I further certify that I have read and understand the terms of this animal surrender form. I Certify That the Above Information is True and Accurate: (enter name for signature)*