Owner Surrenders Form

Please provide all requested information to the below questions. These answers will help us determine how we can best help you and your pet. 

I acknowledge that Cedartown Polk County Humane Society has made no promises regarding the surrendered animal(s) beyond the inclusion in its care and adoption program. I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Animal Surrender Form, hereinafter referred to as “the animal.” I hereby surrender any and all property rights of the animal. I release and discharge CPCHS from any and all claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the animal(s) and agree to hold harmless CPCHS from and against any and all such rights claims, obligations, liabilities and causes of action which may be asserted by other parties. I certify that no other person has a right of property to the animal. I understand that by surrendering my property rights to the animal, the animal may be transferred into the custody of an animal shelter. I also hereby certify that the animal has not bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and understand the terms of this Animal Surrender Form.THIS IS A LEGALLY BINDING CONTRACT AND DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR ANIMAL(S) TO CEDARTOWN POLK COUNTY HUMANE SOCIETY.