Georgia Humane Center
Pet Surrender Form
Questions marked by * are required.
1. Name (for surrender of ownership of the following pet(s)): *
2. Name of Pet: *
3. Breed: *
4. Age of Pet: *
5. Is it spayed or neutered? *
6. Do you have Proof of Vaccines? *
7. Why are you surrendering your pet? *
8. The above named owner agrees to the following; 1. He/she is the legal owner of this pet and no other person or persons can claim ownership. 2. Once this agreement is signed by both parties the owner has no legal claim to the pet and gives GHS full ownership even if the owner agrees to foster the pet until a new home can be found. 3. If there is a foster agreement, you agree to immediately give the pet at any time to GHS upon request. 4. If you refuse to surrender the pet once a new owner has been approved for adoption, you agree to reimburse GHS for the full amount of the adoption fee. 5. If possession is given to GHS on the day of this agreement you will provide all current health records and understand that GHS will place the pet in a foster home until a permanent home can be found. Owner Signature - By typing your name, you are electronically signing this form: *
9. Address 1: *
10. Address 2:
11. City: *
12. State: *
13. Zip Code: *
14. Email: *
15. Phone: *