Owner Surrender Form - The Moon Dog Farm

Owner Surrender

MDF relinquish request & contract

"*" indicates required fields

Please fill out this form to the best of your ability. Your answers will help us get to know the animal in question and will ensure that if we are able to place your pet in a foster home or a new home, that the home is adequate for the needs of the animal. Above all, please be honest- failure to be honest with us can cause multiple issues, from the animal being placed in an incorrect foster with our program to legal issues for you and our rescue. Filling out this request does not guarantee that The Moon Dog Farm will take your animal(s).

By selecting submit at the end of this application to relinquish, you are acknowledging that you understand the above. You are also acknowledging that you understand that MDF might be unable to take your pet at the time of this inquiry, and that all parts of this application have been answered honestly and in their entirety.

Name*

Phone number

Email Address*

Address*

Street Address Address Line 2 City State ZIP Code

Where did you get your pet? Pet store, breeder, shelter, rescue, or? Please explain.

What species is the animal(s) you are surrendering?

*PLEASE INDICATE IF YOU ARE RELINQUISHING MULTIPLES OR IF THERE IS A SUSPECTED PREGNANCY*

Name(s) of animal(s)*

Please give a brief description of the animal(s), including: breed, age, color, weight, etc.*

Please upload a photo or photos of your animal(s)

Max. file size: 128 MB.

Where and when did you get the animal(s)?

Describe the circumstances under which you have decided to surrender your animal(s)

Is this animal(s) spayed/neutered?

Is/are your animal(s) microchipped?

Has your pet been to the vet recently? If so, when and for what reason?

Is/are the animal(s) currently on medication and/or have any health problems?*

Describe the animal(s) current habitat. Please be detailed.

Is your animal(s) used to drinking from a bowl or a water bottle?

Describe your animal(s) normal everyday diet (please include and brand names, quantity, and frequency of feedings)*

Is the animal(s) litter box trained? Please describe the extent of their litter habbits.

What kind of litter do you use? (ie. Carefresh, newspaper, pine pellets, etc)

Are there any other pets are in the home?

Help us get to know your pet...

Complete the following so we can best match them with the perfect foster home and adoptive family!

MEET

HE/SHE IS A

OLD.

THE FIRST THING YOU'LL NOTICE ABOUT HIM/HER IS

SHE/HE CAN ALWAYS BE FOUND

THE BEST THING ABOUT HIM/HER IS

SHE/HE COULD USE SOME PRACTICE WITH

FINDING A

HOME WOULD CHANGE THIS PRECIOUS ANIMAL'S WHOLE WORLD!

What are 3 words that describe your animal(s) personality*

Is there anything else you want to tell us about your animal(s)?

Relinquish will be stressful for your pet. In order to make this transition as comfortable as possible for him or her, we ask you to please give any belongings (toys, blankets, carrier, cage) and remaining supplies (food, hay, treats) only make the process more comfortable for them. Please list items that will accompany your pet on the day of transfer to MDF:

I certify that this pet has been in my custody and under my supervision and that, to the best of my knowledge, has not bitten any person or animal or has not been exposed to rabies within the past 10 days.

Yes, I agree

I understand by releasing the Animal(s) to MDF, I relinquish all ownership or other interest in the Animal(s). I will not seek further information about the Animal(s). I will not press MDF for details. My contact with the Animal(s) terminates at the time of surrender. MDF is under no obligation whatsoever to follow up with information.

Yes, I agree

I acknowledge that I am releasing the Animal(s) completely and voluntarily and that no representations, considerations or promises of any kind have been made to me by MDF or any of its representatives.

Yes, I agree

I hereby release and forever discharge MDF 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 MDF from and against any and all such rights, claims, obligations, liabilities and causes of action which may be asserted by third parties.

Yes, I agree

Signature*

Date*

Date

Quality exotic veterinary care is expensive. Once your pet becomes part of The Moon Dog Farm family, he or she will immediately have a wellness exam and any additional care required as it presents. Our rescue operates on donations; are you able to make a monetary donation to help? No amount is ever too small.

Are you able to make a monetary donation to help?

Yes