Owner Full Name

Owner Email Address

Owner Address

Owner City, State, & Zip

Owner Phone Number

Your Vet's Name and Phone Number

I have disclosed any and all material information regarding the medical behavioral history of said animal(s). I willfully surrender all medical records and information and give GARD and its representative’s permission to contact the treating veterinarian for any records or information which might be in their possession. I have disclosed any and all material information regarding the medical behavioral history of said animal(s). I willfully surrender all medical records and information and give GARD and its representative’s permission to contact the treating veterinarian for any records or information which might be in their possession. Yes No

First Animal Name, Breed, Color, Age (best guess)

First Animal's Sex First Animal's Sex Male Female

Is the first animal spayed or neutered? Is the first animal spayed or neutered? Yes No Don't Know

Second Animal Name, Breed, Color, Age (best guess)

Second Animal's Sex Second Animal's Sex Male Female

Is the Second animal spayed or neutered? Is the Second animal spayed or neutered? Yes No Don't Know

Third Animal Name, Breed, Color, Age (best guess)

Third Animal's Sex Third Animal's Sex Male Female

Is the Third animal spayed or neutered? Is the Third animal spayed or neutered? Yes No Don't Know

I acknowledge that Georgia Animal Rescue & Defence, Inc. has made no promises regarding the surrendered animal(s) beyond the inclusion in its care and adoption program. 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 of the animal. I release and discharge GARD from any and all claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the animal(s) and agree to hold harmless GARD from and against any and all such rights claims, obligations, liabilities and causes of action which may be asserted by other parties. I certify that no other person has a right of property to the animal. I understand that by surrendering my property rights to the animal, the animal may be transferred into the custody of an animal shelter. I also hereby certify that the animal has not bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and understand the terms of this Animal Surrender Form.THIS IS A LEGALLY BINDING CONTRACT AND DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR ANIMAL(S) TO Georgia Animal Rescue & Defence. I acknowledge that Georgia Animal Rescue & Defence, Inc. has made no promises regarding the surrendered animal(s) beyond the inclusion in its care and adoption program. 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 of the animal. I release and discharge GARD from any and all claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the animal(s) and agree to hold harmless GARD from and against any and all such rights claims, obligations, liabilities and causes of action which may be asserted by other parties. I certify that no other person has a right of property to the animal. I understand that by surrendering my property rights to the animal, the animal may be transferred into the custody of an animal shelter. I also hereby certify that the animal has not bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and understand the terms of this Animal Surrender Form.THIS IS A LEGALLY BINDING CONTRACT AND DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR ANIMAL(S) TO Georgia Animal Rescue & Defence. Yes No