Owner Surrender Form

Name of animal:

Breed:

Color:

Age:

Date of birth (if you know):

Gender:

Spayed or neutered:

Are you the sole caregiver for the animal:

If you answered no to the above question, who else cares for this animal and in what capacity?

Name of current Veterinarian:

Contact information for current Veterinarian:

Please explain why you are surrendering this animal to High Plains P.A.W.:

I HEREBY STATE THAT I AM GIVING UP MY ANIMAL OF MY OWN FREE WILL.

I understand that upon giving my animal to the above named organization, that organization becomes the SOLE OWNER OF THE ANIMAL. I will make no attempt to reclaim said animal. I fully grant this organization the right to give said animal any medical treatment deemed necessary, and to possibly place the animal in a good adoptive home. Should a veterinarian determine that said animal is too ill to be treated, if necessary, I give the above named organization the right to put said animal humanely to sleep. I release the above named organization from all liability concerning the care of said animal under the agreement that the above named organization will make every attempt to provide adequate care and find a permanent home for said animal.

Please again sign below: