Miscellaneous Surrender Form Please contact us before submitting a surrender form. Do not use this for for dogs or livestock. They have their own forms. First Name: Required Last Name: Required Address: Required City: Required State: Required Zip: Required Phone: Required Cell Phone: Required Email: Required Re-enter Email: Required Why are you surrendering this animal(s)? Required List animal(s) you wish to surrender & any details about the animal that we should know. Required I certify that I am the owner of, or have authority to surrender to TRHAP, the animal described above. I hereby relinquish all rights of ownership and any right to information on the disposition of said animal. I also authorize the release of any veterinary records regarding this animal. I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behavior, history and anything else that may affect the safe placement of the animal in a new home. All statements made above are true and correct. Please Initial: Required I hereby acknowledge that I have been notified of and fully understand the following conditions of my relinquishment of this animal: 1)TRHAP shall have sole and exclusive legal right to make all outcome decisions and take all actions deemed appropriate, including return to owner, adoption, or euthanasia. 2) At no time in the future will TRHAP be required to communicate the outcome of the animal to you or any other party. Please sign below: Required