Owner Relinquish Form, Bainbridge Humane Society

Bainbridge Decatur County Humane Society
Owner Relinquish Form for your Animal


By Entering Into This Written Agreement With The Bainbridge – Decatur County Humane Society, I Am Relinquishing All Right To The Animal Described Herein. Upon Execution Of This Agreement, The Humane Society Immediately Becomes The Owner Of This Animal And, At Its Discretion, Has The Right To Either Put The Animal Up For Adoption Or Humanely Euthanize The Animal.

Your Name
eMail Address
Telephone
Name of person relinquishing animal *
Address
City/State/Zip
Telephone Number
Cell Phone
Description Of Animal
Animal Name
Gender of animal
Age of animal
How long have you had this animal
Species
Breed
Coloring/Markings
General condition/temperament
Known medical problems
Has animal been spayed/neutered?
When
Where
If female, has animal ever had a litter?
If so, how many times?
Date of last litter?
Is animal current on rabies shot?
Next Due
Other Shots?
Has Animal Been Tested For Heartworms?
When
Is Animal On Prevention?
Next Due
If Cat, Has Animal Been Tested For Feline Leukemia?
When
Where
Is Animal On Flea Control Medication
What
When
Who Is Your Veterinarian?
Animal Last Seen By Vet?
Reason Last Seen
Is Animal House-Broken Or Litter Box Trained?
Good With Children?
Good With Other Animals?
Has Animal Lived Primarily Inside Or Outside?
Why Are You Relinquishing This Animal?
If You Are Not The Owner Of This Animal, What Is Your Relationship To The Owner
And Why Are You And Not The Owner Bringing In The Animal?
Circumstance You Would Consider Keeping The Animal
Do You Currently Have Other Animals?
What Kind And How Many?
Location Where Animal Resided
City of Bainbridge City of Attapulgus City of Brinson City of Climax Unincorporated area of Decatur County City of Donalsonville City of Iron City City of Jakin Unincorporated area of Seminole County City of Colquitt City of Blakely Unincorporated area of Miller County City of Camilla Unincorporated area of Mitchell County City of Whigham City of Cairo Unincorporated area of Grady County Other location
This Agreement Is Not Valid Until And Unless Signed By Owner And Accepted by Humane Society Representative
The Humane Society Immediately Becomes The Owner Of This Animal And, At Its Discretion, Has The Right To Either Put The Animal Up For Adoption Or Humanely Euthanize The Animal.
Please Type Name for Required Signature