BARC-CT Surrender Form

It all started when...It all started when...It all started when...It all started when...

By signing this form, I state I am the owner of the animal(s) who is/are the subject of this animal surrender form, hereinafter referred to as “the animal”. To my knowledge, no other person has any right to this animal. I hereby surrender all the rights to the animal to BARC-CT, (Bridgeport Animal Rescue Crew of Connecticut). I understand that once I relinquish the animal, the animal will not be available to be returned. I have read and understand the terms of this animal surrender form.

Name *

Name

First Name

Last Name

Date *

Date

YYYY

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address *

Animal Information — Pet 1. (Please Answer All Questions)

Animal Information (continued)

Spay Neuter | Color | Last Vet Visit | Current Vet Name

Animal Information — Pet 2. (Please Answer All Questions)

Animal Information (continued)

Spay Neuter | Color | Last Vet Visit | Current Vet Name

Signature *