Animal Surrender Form Blue Barn Rescue Animal Surrender Form Date * MM DD YYYY Owner Information Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Pet Information Pet's name: * Type of Pet: * Chicken Donkey Duck Goat Guinea Pig Hamster Mini Rabbit Rat Sheep Color and Description: * Sex: * Spayed/neutered? * Yes No I don't know Age/ DOB: * Diet: * Are there any known medical conditions? * If yes, please list medical conditions and what medications were prescribed, if any. Any aggression? * If yes, please explain. Likes/ dislikes? Last visit to the vet? * Up to date on vaccines? * If yes, please send vaccine certificate to mary@bluebarnrescue.org Reason for surrender: * Household Demographics: This section is so that we can see what your pet is used to and helps us match your pet with a new home. Age and sex of ALL members of the household * Please list all pets you currently own: * Please list, type of pet, age, sex and whether they are spayed/neutered. If none, please write "none" 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. 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 will be transferred into the custody of Blue Barn Rescue. I also hereby certify that the animal has/has not [circle one] bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the animal to Blue Barn Rescue, 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. * *BBR requires a donation for all owner surrenders to help with the expenses to care for your pet. This is a small portion of the actual cost of caring for your pet. Suggested donation TBD based upon the type of pet and whether your pet is deemed adoptable by BBR, or must stay in the sanctuary. ** ** By signing this form, i understand and agree to the liability waiver terms in the event that I visit Blue Barn Rescue during the surrender process. Date * MM DD YYYY Thank you for submitting your application! We will review your application and someone will get back to you within 24-48 hours. To view liability waiver terms, click HERE. Surrender Donation
