Animal Surrender Agreement


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 , hereinafter referred to as “the animal.” I hereby surrender any and all rights to the animal. I certify that no other person has a right to the animal. I understand that by surrendering my rights to the animal, the animal(s) will be transferred into the custody of M.I.T Mixed Breed Rescue. 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 Agreement.


Owner’s Signature:  ______________________________________________

Owner’s Name:  ____________________________________________________

Owner’s Address:  _____________________________________________________________________

Owner’s Phone Numbers:   __________________________ 

Owner’s E-mail:  ___________________________________

Donation Amount: ________________                        

Please complete the section below (include all animals).


1. ❑Cat ❑Dog                       ❑Female❑Male                                ❑Puppy ❑Adult ❑Senior

  Name                            Breed                                Color


2. ❑Cat ❑Dog                 ❑Female❑Male                       ❑Puppy ❑Adult ❑Senior

  Name                             Breed                                 Color


3. ❑Cat ❑Dog                 ❑Female❑Male                       ❑Puppy ❑Adult ❑Senior

  Name                             Breed                                 Color


M.I.T Mixed Breed Rescue is a 501(c)(3) non-profit organization.

We are dedicated and passionated to place the pets we rescue in a good home.