Animal Information:

Name:

Color:

Microchip#:

Species:

Breed:

Gender:

Age:

Wgt:

Owner Information:

Name:

Contact phone #:

Email:

Mailing Address:

An owner can only relinquish ownership of an animal if we are certain they are truly the legal owner of the animal!

Ownership confirmed by:

1. Proof of pre-existing microchip coded to this owner + owner's photo ID

2. Animal's Registration papers + owner's photo ID

3. Other:

If "other" then Supervisor must sign form that identity is confirmed:

Reason for relinquishment:

Are there other options that you would like to consider before signing ownership of your animal over to ARG? Can we help you explore those options? Would foster care help? Just to be sure, we will hold the animal for an additional 10 days after the date you sign this form before making it eligible for permanent adoption. If you have a change of heart, notify us in writing within the 10 day cooling off period. At the end of the 10 days, if we have not received written notification from you that you wish to reconsider relinquishment, then this animal will be eligible for permanent adoption to a new home. You will not be provided with information on the new owner. If the animal is registered, then registration papers must be signed over to ARG at the time of relinquishment.

Owner's Signature:

Date:

Time:

Witness:

ARG# if member:

Witness:

ARG# if member:

At least one witness must be a current ARG member duly signed in as personnel for this incident.