First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Animal being surrendered:*
Choose one: Dog Cat

What is the name of the animal being surrendered?*

Age of animal being surrendered?*

Breed of animal?*

What is the sex of this animal?
Choose one: male female

Reason you are surrendering this animal to Krewe de Rescue.*

Is this animal spayed/neutered and up to date on vaccinations? Check all that apply

Please get copies of any vet records you have for this animal to give to Krewe de Rescue upon surrendering this animal.

By typing my name in the box below, I certify that I am the rightful owner/keeper/caretaker/custodian of the animal who is the subject of this animal surrender form ("Animal"). I hereby surrender any and all property rights to the animal to The Mobile County Humane Society, Inc /dba Krewe de Rescue. I certify that no other person has a right of property to the animal. I understand that once I relinquish the animal, it will not be available to be returned. I further certify that I have read and understand the terms of this animal surrender form and agree to be bound by them.*