The Chicken Rescue - Animal Surrender Form
Description
Name *
Your answer
Address (street) *
Your answer
Address (city and state) *
Your answer
Phone number
Your answer
Email address *
Your answer
Number of chickens to surrender *
Your answer
Gender *
Breed(s) (otherwise answer "unknown ") *
Your answer
Name, age, color and gender of each chicken.
* Please list each one individually *
Your answer
List any injuries or illnesses you are aware of (otherwise answer "none" or "unknown") *
Your answer
How soon do you need to surrender your chicken(s) *
Your answer
Please explain the reason for surrender *
Your answer
I certify that I am the owner of the chicken(s) described above. I agree to relinquish ownership of any and all rights and privileges related to the chicken(s) described above to The Chicken Rescue. *
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