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
Description Of Animal
Animal Name
Species
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.