ANIMAL SURRENDER FORM

I hereby release and forever discharge BALLYDIDEAN FARM SANCTUARY from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the Animal(s), and I agree to indemnify and hold harmless BALLYDIDEAN FARM SANCTUARY from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties. I have fully read and understand this Surrender Agreement. I accept and agree to abide by its terms.

Name

First Name

Last Name

Animal(s)

Age, Sex, Breed, Species, and coloring the animal(s). (e.g. 9 year old female Nigerian Dwarf goat. Brown, black, white, and gold spots)

Veterinarian

The current vet, if any

Date

YYYY

Signature

I hereby certify that I am the rightful guardian of the animal(s) who is/are the subject of this Animal Surrender Form, hereinafter referred to as “the animal(s).” I hereby surrender any and all property rights to the animal(s) to BALLYDIDEAN FARM SANCTUARY. I certify that no other person has a right of property to the animal(s). I have disclosed all material information regarding the medical and behavioral history of the animal(s). I will willfully surrender all medical records and information pertaining to the animal(s). I have granted permission to contact my veterinarian for any necessary information pertaining to the animal(s) and I hereby consent to the release of any and all medical information by any medical provider. I understand that once I relinquish the animal, the animal will not be available to be returned and BALLYDIDEAN FARM SANCTUARY has no obligation to follow up with information about the animal(s). I hereby release and forever discharge BALLYDIDEAN FARM SANCTUARY from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the Animal(s), and I agree to indemnify and hold harmless BALLYDIDEAN FARM SANCTUARY from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties. I have fully read and understand this Surrender Agreement. I accept and agree to abide by its terms.