Intake Form

I, (INSERT YOUR NAME ), an adult, do hereby voluntarily and irrevocably give, donate, surrender and release to Desert Cat Rescue & Sanctuary of Arizona, hereinafter referred to as DCRSA, the following animal(s), hereinafter referred to collectively as “Animal(s)”.

I represent and warrant that I am the lawful owner of the Animal(s), and I have full power and authority to surrender the Animal(s) to DCRSA. No other person has any legal or equitable ownership interest in the Animal(s).

I have disclosed to DCRSA all material information regarding the medical and behavioral history of the Animal(s). I willfully surrender all medical records and information pertaining to the Animal(s). DCRSA has my permission to contact my veterinarian for any necessary information pertaining to my Animal(s), and I hereby consent to the release of any and all medical information by any medical provider.

I further acknowledge that I am releasing the Animal(s) completely voluntarily and that no representations, considerations or promises of any kind have been made to me by DCRSA or any of its representatives.

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 by releasing the Animal(s) to DCRSA, I relinquish all ownership or other interest in the Animal(s). I will not seek further information about the Animal(s) and will not press DCRSA for details. My contact with the
Animal(s) terminates at the time of surrender. DCRSA is under no obligation whatsoever to follow up with information about the Animal(s).

I hereby release and forever discharge DCRSA from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the Animal(s), and I agree to indemnify and hold harmless DCRSA from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties.

I have fully read and understand this Surrender Agreement. I accept and agree to abide by its terms.

Veterinarian's Name

Veterinarian's Phone Number

Veterinarian's Address

For each animal, please write their Specie, Name, Sex, Age, and Color.

How old is the animal?

Positive Behaviors for each animal

Negative Behaviors for each animal

Has the animal lived with other animals? If so then what kind?

How does the animal act around children?

How does the animal act around other animals?

Who does the animal not get along with?

How long have you had the animal?

What kind of personality does the animal have (ie. laid back, playful, dependent, shy)

Additional comments

I understand that I cannot ask for this/these animal(s) back after this form is submitted to Desert Cat Rescue & Sanctuary of Arizona and this/these animal(s) is/are now under the complete ownership of Desert Cat Rescue & Sanctuary of Arizona.
Submitting this form reflects that I have read and understand the information provided above
and I am hereby releasing all rights for this animal(s) to Desert Cat Rescue & Sanctuary of Arizona