This Adoption Surrender Agreement ("Agreement") is entered into as of by and between:

Surrendering Party ("Owner"): Address: Phone: Email:

Receiving Organization ("Adoption Agency"): Address: Phone: Email:

1. Animal Details

Name: Species/Breed: Age/Date of Birth: Color/Markings: Microchip/ID:

2. Surrender Terms

The Owner certifies that they are the legal owner or authorized agent of the above animal and voluntarily surrenders all rights, claims, and ownership of the animal to the Adoption Agency. The Owner affirms that to the best of their knowledge, the information provided is accurate and that the animal has not bitten or injured anyone, .

The Owner understands this surrender is permanent and waives all future claims to the animal.

3. Medical Information

Vaccinations up to date: Known Medical Issues: Current Medications: Date of Last Vet Visit:

4. Additional Comments

5. Signatures

Owner Signature: Date:

Adoption Agency Representative Signature: Date: