Dog History/Owner Animal Surrender and Relinquishment Form

Owner's Name *

Address *

Phone Number *

Email *

Animal's Name *

Species *

Gender *

Color *

Breed *

Age *

Owner's reason for parting with animal *

Has the animal lived with children? *

Has the animal lived with animals other than cats and dogs? If so, please specify behavior around these other animals. *

Has the animal been spayed/neutered? *

Does your animal have any medical conditions that are undergoing treatment? *

Does your animal have any known allergies? *

Is he/she prone to biting? Describe any bites in detail with dates and descriptions of incidents. *

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I hereby certify that I am the owner of the animal described on this form or I am the authorized representative of the guardian or owner of the animal described above.

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I certify that I have unrestricted and complete authority to convey, surrender, and relinquish the animal to the Tucker County Animal Shelter and hereby relinquish ownership any and all property rights to Tucker County Animal Shelter.

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I certify that the animal has not bitten, scratched, or attacked anyone in the last 10 days.

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I understand that I am relinquishing this animal to the Tucker County Animal Shelter and I acknowledge and agree that this animal will not be returned to me, TCAS will have sole and exclusive legal right to make all decisions, and to take all action regarding the animal. The decision to euthanize is within the sole discretion of TCAS. I further understand and agree that this means that the animal I am relinquishing may be euthanized at any time after its arrival.

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I understand that I will not be contacted before an animal is adopted, transferred to another rescue or shelter organization for adoption, or euthanized.

I understand that there is an owner surrender fee to relinquish an animal to Tucker County Animal Shelter. I acknowledge the following:

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I hereby release Tucker County Animal Shelter and its employees, staff, agents, and/or representatives from any claims or demands that I have or may have that: a) may be connected with the animal b) may arise of TCAS care of the animal c) may arise from TCAS euthanizing this animal

Please upload a clear image of your government-issued photo identification. We require all persons surrendering animals to provide verification of photo ID to ensure that we are verifying that the animal belongs to the person surrendering. *

My verifications of agreement above and signature here certify that the above statements are true and correct, and relinquish all rights and ownership in the animal described on this form to the Tucker County Animal Shelter and acknowledge my agreement to all statements in this Owner Animal Surrender and Release Form *