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Relinquish Form & Agreement
PHOTO ID REQUIRED-TARZAN'S SAFE HAVEN MUST KEEP A COPY

We understand that relinquishing any pet can be a very difficult and emotional time for you, your family and your pet(s). Please help us insure from this point forward your pet(s) will be given the best chance to be adopted into a new home and take the time to fill out this form completely and to the best of your ability.

Type Your Full Name As A Digital Signature of Acceptance
Your answer
Contact Information Phone and Email
Your answer
Address
Your answer
Relinquished Pet(s) Information:Type of animal, Name, Sex, Age, Reason for Relinquishing
Your answer
Are they spayed or neutered?
This letter is stating that the above named, the owner of the animals listed above, is voluntarily giving up ownership of this/these animal(s) to a new owner. It is understood that this agreement is final and even if the health or behavior of this animal(s) improves, or if the relinquishers situation changes and can care for this animal(s) again, the animal(s) will not be returned. With this agreement, it is understood that any medical services and their fees that are involved from this point forward are not the relinquishers responsibility. Also, if the new owner decides to euthanize this animal(s), the relinquisher will not be contacted.
May we contact you if we have any further questions?
Is your pet(s) up to date on their vaccinations?
When was their last veterinarian visit?
Your answer
Veterinarian Name & Number
Your answer
If relinquishing for behavioral issues, explain the issues be specific and how long have they occurred?
Your answer
If relinquishing for medical issues, explain the issues be specific and how long have they occurred?
Your answer
What likes and dislikes does your pet(s) have, be specific, including but not limited to special toys, treats, personal contact, personal space, sleeping arrangements, ect.?
Your answer
Is there any other information about yourself, your home, or your pet(s) that could help us place this animal(s) in the correct home?
Your answer
Please list any additional items you will be leaving with Tarzan's Safe Haven along with your pet(s) (i.e. kennel, carrier, bowls, toys, ect.)
Your answer
I, the relinquisher named above, understand that Tarzan's Safe Haven will, to the best of their ability, rehabilitate the animal(s) left in their care and find them the most suitable home(s) possible. I agree and understand that by relinquishing my animal(s) I will no longer have a say or be contacted with any further decisions made about these animal(s) in any manner.
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