Owner Surrender Form

Name *

First

Last

Phone *

Email *

Name of Veterinary Clinic *

Vet Phone Number *

I would like to receive updates about this animal via text or email to the phone number or email address I provided above *

Animal Information

Animal's Name *

Age *

Birthdate (if known)

Sex *

Spayed or Neutered? *

Please agree to the following: *

I agree

I understand that upon giving my animal to Newman Nation: Senior Pets United, the rescue becomes the sole owner of the animal. I will make no attempt to reclaim my animal. I hereby voluntarily and irrevocably give, donate, surrender, and release to Newman Nation: Senior Pets United this animal. I represent and warrant that I am the lawful owner of the animal and I have full power and authority to surrender the animal to Newman Nation: Senior Pets United. No other person has any legal or equitable ownership interest in the animal. I have disclosed all material information regarding the medical or behavioral history of the animal. I willfully surrender all medical records and information pertaining to the animal. Newman Nation: Senior Pets United has my permission to contact my veterinarian for any necessary information pertaining to my animal and I hereby consent to the release of any and all medical information by any medical provider.